Neuropathy In India

Today's post from India's dailypioneer.com (see link below) gives us a rare glimpse into how other countries view neuropathy and what sort of problems it presents. As you can imagine, in such a vast country as India, neuropathy statistics are alarmingly high but that's not surprising given the population. Nevertheless, the story is the same as it is across the world. It's also worth remembering that new treatments for neuropathy are just as likely to come from India as from any other area of the world - the Indian pharmaceutical industry is booming!

Best foot forward in diabetic neuropathy
Sunday, 23 April 2017 | Dr Mukul Verma |

An estimated 50 per cent of all diabetic patients develop painful diabetic neuropathy in 25 years, writes Dr Mukul Verma

Warmth of a bonfire, freshness of breeze, softness of a cuddly toy — how do we feel all these are sensations? Through the network of nerves that travel throughout the body and convey these feelings to the brain in the form of electrical signals. This relay of information to the brain and back to the sense organs goes on smoothly without a hitch continuously for a lifetime. However, diabetes has the power to collapse this master communication system and blow its circuits out. Prolonged exposure to high glucose levels leads to nerve damage and this is called diabetic neuropathy. It is estimated that about 50 per cent of all diabetic patients develop painful diabetic neuropathy in 25 years.

Diabetic neuropathy can affect nerve fibers throughout the body, but most often, damages nerves in the legs and feet. This is called peripheral diabetic neuropathy. It is more common when blood sugar remains uncontrolled for a long time. Uncontrolled diabetes is rampant in India, in fact 50 to 60 per cent of diabetic patients do not achieve the glycemic target of HbA1c below 7 per cent. With a diabetic population of more than 62 million, the projection for diabetic neuropathy incidence are indeed worrying.

Some common signs of diabetic neuropathy are:
A tingling or burning sensation
Sharp pains
Muscle cramps
Increased sensitivity to touch
Numbness
Reduced ability to feel temperature changes
Muscle weakness
Loss of balance and coordination

The symptoms of peripheral neuropathy depend on the type of nerves that have been damaged. There are three types of peripheral nerves: Motor, sensory, and autonomic. Sometimes all three types of nerves are affected, and this condition is called polyneuropathy. The symptoms vary from patient to patient. Some years ago, I had a 70-year-old patient who complained that his feet “were on fire”. And one 65-year-old had a constant complaint that she was unable to understand where her feet were.

About 10 per cent of diabetic patients experience persistent pain. This is called chronic diabetic neuropathy. The pain typically worsens at night. For some, the pain of diabetic neuropathy may be bearable, for others it may be severe enough to cause sleeplessness, reduce their activity levels, and interfere with their routine.

In a cross-sectional study carried out to assess the burden of diabetic neuropathic pain, about 50 per cent patients reported moderate to severe pain-related interference in activities of daily living. Fifty-seven per cent patients reported an adverse impact on their employment status. Among those currently working, 72 per cent reported reduced productivity, including 22 per cent who reported reduced productivity “most” or “all” of the time.

Diabetic neuropathy pain can cripple the enjoyment of life. Moreover, it can be literally crippling too as it is the leading reason behind diabetic foot ulcer and amputation. This is mainly because the sensory loss associated with diabetic neuropathy can prevent the patient from recognising foot issues like injuries till it is too late.

In India, the awareness about diabetic neuropathy is rather poor. Most diabetics tend to ignore it, thinking that it is a normal part of ageing. However, this is a dangerous trend as it can lead not only to the loss of quality of life but also to the loss of a limb.

I have noted that patients come to specialists like me as a last resort after trying a variety of over-the-counter medications and home remedies. This can do more harm than good as common painkillers are usually ineffective in combating diabetic neuropathy pain. This self-medication may also lead to an unnecessary delay of proper treatment and gastric side-effects.

Awareness about the need to initiate specific protective pain relief medication in diabetic neuropathy is a priority in India today. Early treatment should be sought to prevent the progression of neuropathy and control pain.

Research is going on all over the world to discover therapies to end the agony of neuropathy. A therapy aimed at producing drugs which target the brain immune cells responsible for causing pain is still in its nascent stages. A gene-based therapy, which will induce regeneration of nerves, is also being researched.

But right now, there is no known cure for diabetic neuropathy; it can be only managed better with the help of some prescription medicines, which only a doctor can prescribe. Hence, to be able to put your best foot forward for living well with diabetes neuropathy, it is essential to consult a pain specialist as early as possible and initiate the right treatment.

The writer is a Neurologist, Apollo Hospital, Delhi

http://www.dailypioneer.com/sunday-edition/agenda/miscellany/best-foot-forward-in-diabetic-neuropathy.html