34.2 million Americans have diabetes, that is 1-10 and 1-3 are pre-diabetes, with the highest incidence in the Black and Hispanic population. World -wide, the United States has the highest prevalence of diabetes in the ages of 20-79, 11% of the population of the US are diabetics. States with the highest incidence of diabetes include:
- West Virginia 15.7%
- Alabama 15.0%
- Mississippi 14.6%
- Louisiana 14.3%
Approximately 50% of people with type 2 diabetes and 20% with type 1 diabetes have peripheral neuropathy. About 60-70% of all types of diabetics will eventually develop peripheral neuropathy.
Peripheral neuropathy is a damage to the nerves outside of the brain and spinal cord. It causes numbness and pain in the hands and feet but can also affect bodily functions such as circulation, digestion and urinary function. Peripheral neuropathy refers to conditions that result when nerves carrying messages from the brain and spinal cord are damaged. These damaged nerves connect the brain and spinal cord to muscles, skin and the internal organs. When the communication is interrupted this impairs normal sensation, muscle movement and can cause pain.
Types of Peripheral Neuropathy
Neuropathies are typically classified by the type of damage they cause and the nerves involved
- Mononeuropathy- Damage to a single nerve
- Polyneuropathy- multiple nerves involved
Mononeuropathy
Most common cause is trauma to the nerves or pressure on the nerve examples are:
- Carpal Tunnel Syndrome causing numbness and tingling in the fingers of the hand
- Peroneal Nerve Palsy causing muscle weakness in lifting the foot (foot Drop)
Autonomic neuropathies can also affect internal organs such as blood vessels, bladder function and the intestines. They can affect blood pressure and temperature regulation.
Polyneuropathy
Multiple nerves malfunction at the same time. The number one cause is diabetes. Other causes nutritional deficiencies, cancer, organ failure ( kidney) alcohol or drug abuse, medications, thyroid disease, infections and auto-immune diseases
Common symptoms of polyneuropathy
- Tingling
- Numbness
- Burning sensation
- Loss of sensation
- Pain
- Bowel or Bladder Dysfunction
- Sexual Dysfunction
- Blood Pressure Variations (Low Blood Pressure)
- Paralysis (Guillan-Barre Syndrome)
Common Testing for the diagnosis
- Full History and Physical
- Labs
- MRI or CT- looking for tumors or pinched nerves
- Electromyography- records electrical activity in the muscles and activity in the nerves
- Nerve Biopsy
Treatment
Treatment depends on the etiology of the neuropathy. It could be life -style modification as in exercising, reducing alcohol, quit smoking or eating more nutritional meals. Diabetics should monitor glucose levels and reduce HA1C levels. Carpal Tunnel treatment could use a Brace and Physical Therapy sometimes surgical decompression is necessary, treatment is dictated by the cause and type of neuropathy.
Medicines
Anti-Seizure Meds
- Lyrica
- Neurontin
Side effects are drowsiness and dizziness.
Topicals
- Lidocaine Patches
- Capsaicin- substance found in chili peppers
Side effects cause skin irritation and numbness at the site of application.
Anti-Depressants
- Tricyclic antidepressants
- Serotonin and norepinephrine reuptake inhibitors
Side effects dry mouth, nausea, dizziness , constipation and weight gain.
Pain relievers
- Over the counter meds ( NSAIDS, Tylenol) commonly do not work
- Medications containing opioids
Can lead to dependence. US overdose deaths hit over 100,000 in 2020 a rise of 28%. Narcotics should NOT be used in these chronic pain cases!!!!!
Platelet-Rich-Plasma
Platelet-Rich-Plasma is the processed autologous blood derived product with the platelet concentration above baseline. It is a safe alternative used for more than 30 years in different applications where repair and regeneration of tissues is needed.
Serotonin (5-hydroxytryptamine or 5HT) has critical roles in pain tolerance. It is known that most of the 5HT is produced in the gastrointestinal tract and then taken up and stored in the granules of the platelets at high concentrations.
Most 5HT is outside the CNS where it is involved in the regulation of systemic and biological functions of the body.
5HT has metabolic effects on many different cell types (adipocytes, epithelial and leukocytes), 5HT can stimulate or inhibit inflammation. 5HT actions are mediated through interaction with the 5HT receptors. There are at least 7 members and 14 receptor subtypes including the most recently identified member 5HT-7 which functions in the peripheral tissues for pain processing.
Activated platelets release both pro and anti-inflammatory mediators that can reduce pain. PRP has been used in a variety of clinical pathologic conditions associated with chronic pain. It is postulated that the reduction of pain is due to the platelet released 5HT. Tissues treated with activated PRP release their contents and an abundance of pain modulating 5HT is discharged into the area. With concentrated PRP of 5-7 times the normal concentration of blood ,the amount of this pain modulation is abundant.
The overall understanding of the 5HT system has led to drugs which were formulated to block the reuptake of serotonin once released into the synaptic areas of the neurons thus modulating the signals in chronic pain. In one study of patients suffering from mild to severe neuropathic pain , the pain was eliminated altogether or reduced for years after the PRP application. The final platelet concentration and characteristics that contributed to the constant analgesic effects is key in the application of Platelet-Rich-Plasma. These variables include the delivery methods, the application techniques, the activation protocols and the platelets produced by the donor himself/herself.
Juventix Regenerative Medical has a FDA approved Platelet-Rich-Plasma harvesting kit. It is cost effective, easy to use and the concentrations obtained from the process are reproducible. The Juventix Photo-Activator is patent pending and negates the use thrombin or calcium chloride to activate the platelets. For peripheral neuropathy, especially in the diabetic population, Platelet-Rich-Plasma offers treatment that is devoid of side effects and may provide long lasting relief.
Restore, Revive, Regenerate , Juventix Regenerative Medical
Regenerative Regards,
Dr. Robert McGrath
Sources:
Diabetic Neuropathic Pain: Physiology and Treatment
World J Diabetes 2015 Apr15 ;6(3) 432-444 PMID 25897354
