Diabetic Nerve PaiNA guide for pAtients And fAmilies

featuring Jerry mathersStar of “Leave it to Beaver”

DVDInside

Diabetic Nerve PaiNA guide for pAtients And fAmilies

Copyright 2011

American Academy of Neurology Foundation

All Rights Reserved

No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying or recording, or by any information storage and retrieval system, without the written permission of the publisher, except when permitted by law.

Manufactured in the United States of America

Contents

Introduction................................................................................... 4

WhatIsDiabeticnervePain?....................................................... 7

HowDoIKnowMyPainIsRelatedtoDiabetes?......................... 9

Goalsoftreatment...................................................................... 10

Firststeps................................................................................... 11

MedicinesforDiabeticnervePain.............................................. 13

theImportanceofexercise........................................................ 14

non-MedicinePaintreatments................................................... 15

AlternativeandComplementaryApproachestoPainRelief....... 15

takeCareofYourFeet!............................................................... 16

Findingsupport.......................................................................... 19

Conclusion.................................................................................. 20

Resources................................................................................... 21

DIsCLAIMeR:This guidebook and DVD program is intended for informational purposes only. This program was produced by Conrad Productions and Alan Weiss Productions, with editorial oversight from the American Academy of Neurology Foundation (AANF). Financial support was provided by Pfizer.

The guidebook author is Stephen Braun and the DVD script writer is Deborah Gobble. Complete disclosure information on the physician experts who participated in this program (Dr. John Markman and Dr. Thomas Chelimsky) is available at www.aan.com.

The writers, producers, collaborator and funder make no representations or warranties, express or implied, regarding the accuracy or completeness of the information provided herein.

No one should rely upon this information as the basis for treatment decisions. Anyone requiring medical or other health care should consult a medical or health care professional. Any actions based on the information provided are entirely the responsibility of the user and of any medical or other health care professionals who are involved in such actions.

4 5

IntRoDuCtIon

Ifyouhavediabetes,youprobablyfocusontheday-to-day

needtokeepyourbloodsugarlevelsundercontrol.Youthink

aboutwhattoeat,andwhentoeatit.Youmayneedtothink

abouttakinginsulinoranothermedicinetohelpcontrolblood

sugar.thesearejustpartoflifeforsomeonewithdiabetes.Yet

itisalsoimportanttothinkbeyondtheday-to-day—tothink

long-term.

Diabetescancauseanumberofproblemsthatcreepupslowly.

themostcommonoftheseisnervedamageinthefeetand

hands.thiskindofnervedamagecanleadtodifferentkindsof

symptoms,suchasnumbnessorlackofmusclecontrol.But

themostcommonandtroublesomeproblemcausedbynerve

damageisaburningortinglingpain.

Whenitstrikes,diabeticnervepain,alsoknownasdiabetic

peripheral neuropathy,canbecomethecenterofyourlife.the

painhurts,ofcourse,butitcanalsodisruptsleepandprevent

youfromdoingthethingsyouenjoy.Inaddition,diabeticnerve

paincanleadtoadepressedmood.

thegoodnews:yourriskfordiabeticnervepaincanbelowered

bykeepingyourbloodsugarlevelsclosetothenormalrange.In

addition,manytypesofmedicinesandsomenewdevicescan

helprelievediabeticnervepain.

thisbookletwillhelp.You’lllearnaboutdiabeticnervepainand

waysitcanberelieved.Withpersistenceandthehelpofahealth

careteam,youcanmanagediabeticnervepainandgobackto

thethingsyouenjoyinlife.

DIDYouKnoW?

Manypeopledonotgetany

helpfortheirdiabeticnerve

pain.Ifyouareinpain,tell

yourhealthcareprovider.

Manytoolsexisttohelpyou

manageyourpain.

6 7

WHAtIsDIABetICneRvePAIn?

Painsignalsarecarriedbynervefibersthatrunthroughoutyour

body.nervefibersareverysensitivetohighlevelsofblood

sugar.thedamagefromhighsugarlevelsusuallyoccursslowly.

Yourriskfordiabeticnervepainishigherifyou:

• Havepoorbloodsugarcontrol

• Havehaddiabetesalongtime

• Havehighbloodpressure

• smoke

• Aretall

theendsofthelongestnervefibersareusuallythefirsttobe

damagedbyhighbloodsugarlevels.that’swhypainisoften

feltfirstinthefeet,theninthehands—partsofthebodyfarthest

fromthebrainandspinalcord.thistypeofpainissometimes

calledthe“stocking-glove”pattern.

DIDYouKnoW?

Neurologistsaremedical

doctorswhospecialize

indisordersofthebrain

andnerves.neurologists

canoftenhelppeoplewith

diabeticnervepainand

otherneuropathies.

8 9

thepaincausedbynervedamagecanbemoreintensethan

othertypesoflong-termpain.thepaincantakemanyforms,

including:

• tingling

• Burning

• Prickling

• Cramping

• extremesensitivitytotouch

Diabeticnervepainisoftenworseatnight.thiscandisrupt

yoursleep,leadingtodifficultywiththinkingandmemory,mood

changes,andlowerqualityoflife.

HoWDoIKnoWMYPAInIsReLAteDtoDIABetes?

Likeanykindofpain,diabeticnervepaincan’tbemeasured

directlywithanytestormachine.Butyoucandescribeyour

pain,andusevarioustypesofpainscales,togiveyourhealth

careproviderasenseofpainintensityandquality.

Althoughmanydifferenthealthproblemscancausepaininthe

feetandhands,ahealthcareprovidercanreliablydiagnose

yourpainbyevaluatingforothercauses.Yourhealthcare

providermaydosomesimpletestsofyourreflexes,yourability

tosensethevibrationsofatuningfork,oryourabilitytosense

averylighttouch.

Ifyourcaseisnotclear-cut,youmaybereferredtoa

neurologistforelectronictestsofnervefunction.

DIDYouKnoW?

smokingincreasesyourrisk

ofhavingdiabeticnervepain.

Quittingsmokingisnoteasy,

butitiswellworththeeffort

andcouldloweryourpain.talk

toyourhealthcareprovider

abouthelpwithquitting.

10 11

DIDYouKnoW?

sometimespainsymptomsget

brieflyworsewhenbloodsugar

levelsarebroughtundercontrol.

Butovertime,goodbloodsugar

controlhelpspreventnervepain

anddelaytheonsetofother

problems.

FIRststePs

thefirststepinmanagingdiabeticnervepainistogetyour

bloodsugarlevelsundercontroltopreventfurthernerve

damage.Keepingyourbloodsugarlevelsnormalmayreduce

symptomslikediabeticnervepain.Itmayalsoslowfurthernerve

damage.studiesshowthatgoodcontrolcanlowertheriskof

nervedamageby60%.talktoahealthcareprovideraboutways

toimproveyourbloodsugarcontrol.

eatingahealthyhigh-fiberdiet,exercising,andusingadeviceto

measureyourbloodsugarlevelscanallmakeiteasiertokeep

yourbloodsugarnearnormallevels.

GoALsoFtReAtMent

Ifyouaresufferingfromdiabeticnervepain,youwantthat

paintobereducedasmuchaspossible.that’saperfectly

normalgoal!Currenttreatmentsfornervepaincanusually

reduce,butseldomeliminate,pain.Butifyourpainhasbeen

long-lasting,painreliefmaynotbetheonlygoaloftreatment.

Meaningfulimprovementoftenmeansregaininglost

functioning.thatcouldmeanbeingabletodothingsyou

hadgivenupbecauseofthepain,orbeingabletomoveor

sleepnormally.Reducingpainisoftenjustthefirststepin

thisprocess.Yourhealthcareprovidermayworkwithyouto

createatreatmentplantailoredtothedetailsofyourownlife

andyourownpersonalgoals.

12 13

MeDICInesFoRDIABetICneRvePAIn

Manytypesofmedicinesmayhelprelievediabeticnervepain.

Findingthebestmedicine,orcombinationofmedicines,maytake

sometime.Butworkingcloselywithyourhealthcareprovideris

yourbesthopeoffindingrelief.

Painmedicinesareoftentriedinastep-by-stepmanner.Ifone

medicinedoesn’tworkwell,anothertypeistried.Withdiabetic

nervepain,acombinationofmedicinesoftenworksbetterthana

singlemedicine.thegoalistofindmedicinesthatworkforyou,

withoutcausingintolerablesideeffects.

It’simportanttounderstandthat100%painreliefisusuallynot

possible,nomatterwhattreatmentistried.Yetstudiesshow

thatpeoplereportrealimprovementsinmood,activity,work,

sleep,andenjoymentfromlife(thetrulymeaningfulmeasuresof

successfulpainmanagement)evenwhenpainisreducedbyonly

3pointsona10-pointpainscale.

Painmedicinescomeindifferentforms,includingpills,patches,

andcreams.somemedicinesworkbetterthanotherstotreat

conditionsrelatedtonervedamage,suchasmusclecrampingor

“restlesslegs”symptoms.talktoyourhealthcareproviderabout

whichmedicinesmightbebestforyou.

14 15

tHeIMPoRtAnCeoFexeRCIse

Beingphysicallyactiveisoneofthemostimportantthingsyou

candotoreducenervepainandimproveyouroverallhealthand

mood.theAmericanDiabetesAssociationrecommendsthat

peoplewithdiabetesexerciseatleast21/2hoursaweek.the

exerciseshouldbespreadoveratleastthreedaysperweek.

Youdon’thavetogotoagym!Dailywalking,housework,

gardening,andotherdailychoresallcount.startslowandeasy,

thengraduallybuildup.Andifpainpreventsyoufrombeingmore

active,talktoyourdoctor.

non-MeDICInePAIntReAtMents

Avarietyofdevicesandtechniquesmayhelprelievediabetic

nervepain.Forexample,electricnervestimulatorshavebeen

showntoworkforsomepatients.othermethods,suchas

physicaltherapyortheuseofcold-watertreatments,mayalso

behelpful.Adevicecalledabedcradlecankeepsheetsand

blanketsfromtouchingsensitivefeetandlegs.

ALteRnAtIveAnDCoMPLeMentARYAPPRoACHestoPAInReLIeFRoughly40%ofAmericanshavetriedalternativeor

complementaryapproachesforrelievingchronicconditionssuch

aspain.onlyafewofthesetechniques,however,havebeen

scientificallystudiedfortheirabilitytorelievenervepain.studies

showthatsomeover-the-countertreatmentsmayhelprelieve

nervepain.Alwaystellyourhealthcareprovideraboutany

alternativeorcomplementarytherapiesyoumaybeusing.

16 17

tAKeCAReoFYouRFeet!

Peoplewithdiabetes-relatednervedamagemusttakespecial

careoftheirfeet.thenervestothefeetarethelongestinthe

body.theyaretheonesmostoftendamagedbydiabetes.Pain

isacommonsymptom,butnumbnessandlackoffeelingcan

alsooccur.thatmeanssoresorinjuriesmightnotbenoticed.

thiscanleadtoinfections.Atworst,problemsrelatedto

diabetescanrequireamputationofthefoot.

Herearethingsyoushoulddototakecareofyourfeetifyou

havediabetes:

• Cleanyourfeetdailyusingwarm(nothot)waterandmild soap.Don’tsoakyourfeet,justwashthemanduseasoft toweltodrythemoff.

• Checkfeetandtoeseverydayforcuts,blisters,rednessor otherproblems.useamirrorsetonthefloorifthathelps youseethebottomofyourfeet.

• Keeptoenailstrimmedtotheshapeofthetoesand filedsmooth.

• Wearshoesorslippersinsidetoprotectyourfeet frominjury.

• Wearshoesthatfitwellandletyourtoesmove.

• Breakinnewshoesslowlyandcarefully.

18 19

FInDInGsuPPoRt

Livingwithpainoftencausesarippleeffectthattouchesmany

partsofyourlife.Youmayfeelarangeofemotionssuchasfear,

anger,hopelessness,confusion,andisolation.thosearoundyou

mayhavesimilarfeelings.Individualcounseling—andinsome

cases,counselingwithyourfamily—mayhelp.Manypeoplefind

reliefandsupportfromindividualorgroupcounselingspecifically

focusedonpainandrelatedworries.trainedprofessionals

canactas“paincoaches”toteachusefulskillsandprovide

emotionalsupportandguidance.

Chronicpainsupportgroupsmayalsohelp.Groupscanbe

foundinalmosteverycity,andonlinesupportgroupsexistas

well.Peoplecansharetheirfeelingsandswaptipsthathave

helpedthemmanagetheirpain.(Youcanfindsupportgroups

throughsomeoftheorganizations,includingtheneuropathy

Association,listedatthebackofthisbooklet.)Besuretofinda

supportgroupwithastrongpositiveandupliftingtone.

20 21

ca

reG

iver

ConCLusIon

nowyou’velearnedaboutdiabeticnervepainandthewaysit

canbemanaged.thiskindofpainisverycommon,yetmany

peopledonotgetthetreatmenttheyneed.You’veseenthat

keepingyourbloodsugarlevelsasclosetonormalaspossible

isthekeytoloweringtheriskthatyouwillfeeldiabeticnerve

pain.Manytypesofmedicinesandothertechniquesare

availableaswell.thesemayhelprelievepainandallowyouto

regainactivitiesyoumayhavegivenup.

Ifyouarenotfindinghelpthroughyourregularmedicalcare,

thenaneurologistmaybeabletohelpyouimproveyour

condition.Findingthebesttreatmentmaytakesometrial-and-

error,butwithpatienceandpersistence,youcanfindrelief

fromdiabeticnervepain!

ResouRCes

American Academy of Neurology American Academy of Neurology Foundationaan.com/patients

Neurology Now® MagazineFree magazine for patients and caregivers, courtesy of the American Academy of Neurology.neurologynow.com

Neurology Now Books™

Essential guides for patients and caregivers on various neurologic disorders.aan.com/patients

The Neuropathy Associationneuropathy.org

American Diabetes Associationdiabetes.org

Joslin Diabetes Centerjoslin.org

National Diabetes Education Programndep.nih.gov

National Institute of Diabetes and Digestive and Kidney Diseases diabetes.niddk.nih.gov/dm/pubs/neuropathies

RE

so

uR

CE

s

Funder

Pfizer Inc. thisprogramwasfundedbyPfizerInc.Pfizerisdedicatedtobetterhealthandgreateraccesstohealthcareforpeople.Itspurposeishelpingpeoplelivelonger,healthier,happierlives.Itsroutetothatpurposeisthroughdiscoveringanddevelopingbreakthroughmedicines;providinginformationonprevention,wellness,andtreatment;consistenthigh-qualitymanufacturingofmedicinesandconsumerproducts;andgloballeadershipincorporateresponsibility.everydayPfizerhelps38millionpatients,employsmorethan100,000colleagues,drawsontheskillsofmorethan12,000medicalresearchers,andworkstotreatandpreventillnesses—addingbothyearstolife,andlifetoyears.

22 23

Collaborator

American Academy of Neurology theAmericanAcademyofneurology(AAn),establishedin1948,isaninternationalprofessionalassociationofmorethan22,500neurologistsandneuroscienceprofessionalsdedicatedtopromotingthehighestqualitypatient-centeredneurologiccare.Aneurologistisadoctorwithspecializedtrainingindiagnosing,treating,andmanagingdisordersofthebrainandnervoussystem,suchasAlzheimer’sdisease,multiplesclerosis,epilepsy,strokeandParkinson’sdisease.Formoreinformation,visitwww.aan.com.

American Academy of Neurology FoundationtheAmericanAcademyofneurologyFoundation(AAnFoundation)raisesmoneytosupportvitalresearchintotheprevention,treatment,andcureofbrainandnervoussystemdisorderssuchasdiabeticnervepain.theAAnFoundationiscommittedtoimprovingpatientcare,qualityoflife,andpublicunderstandingofthebrainandotherneurologicdisorders.FormoreinformationortomakeadonationtotheAmericanAcademyofneurologyFoundation,visitwww.buyabrain.org.

24 25

CreditsDiabetic Nerve Pain: A Guide for Patients and Families hasbeenmadepossiblethroughtheexpertise,time,andeffortsofmanyindividuals.specialgratitudeto:

Collaborator

American Academy of Neurology Foundation Contributors to the Video

Thomas Chelimsky, MD, FAAN Chair,AmericanAcademyofneurologysectiononPainDirector,AutonomicDisordersneurologicInstituteuniversityHospitalsCaseMedicalCenterCaseWesternReserveuniversityCleveland,ohio

John Markman, MD, FAAN Chair-elect,AmericanAcademyofneurologysectiononPainDirectoroftranslationalPainResearch/neuromedicinePainManagementCenterAssociateProfessorofneurosurgeryuniversityofRochesterschoolofMedicineandDentistryRochester,newYork

Funder Pfizer Inc.

specialthanksto:Jerry Mathers

Project ManagerCarol BrandenburgExecutive Producer Conrad Productions

Guidebook AuthorStephen BraunMedical WriterAmherst, MA

Guidebook DesignCinda DebbinkDesign Partnersdgdesignpartners.com

the most common complication of diabetes is nerve damage in the feet and hands. this can cause a burning, tingling, intense pain. diabetic nerve pain not only hurts, it can also disrupt sleep, prevent you from doing the things you enjoy, and lead to depression.

the good news: you can lower your risk for diabetic nerve pain by keeping your blood sugar levels close to the normal range. many types of medicines and some new devices can help relieve diabetic nerve pain.

this booklet and dVd will help you learn about diabetic nerve pain and ways it can be relieved. With persistence and the help of a health care team, you can manage diabetic nerve pain and raise your quality of life.

featuring Jerry mathersStar of “Leave it to Beaver”

Diabetic Nerve PaiNA guide for pAtients And fAmilies

Presented by Funded by

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