Can Physical Therapy Relieve Pain From Diabetic Neuropathy?

What is diabetic neuropathy?

Diabetic neuropathies are present in about 50% of individuals with type I or type II diabetes who are over 65 years old or have had diabetes for more than 20 years.

It is the most common complication of diabetes, and the most common neuropathy of the lower limbs.

Diabetic neuropathy occurs when diabetes damages nerve fibers in certain parts of the body. The damage often starts in the feet and can then progress up the legs and throughout the body.

Symptoms experienced by patients often include:

• pain;
• sensory disturbances: tingling, feelings of numbness, reduced sensitivity;
• motor disturbances: stumbling foot, difficulty standing up, etc.

These symptoms can also increase the risk of developing lower limb ulcers.

Since diabetic individuals heal poorly, this can be dangerous and they should be promptly treated.

What are common pains in diabetic neuropathy?

Individuals with diabetic neuropathy often experience pain in their legs and feet. These pains often occur at rest, such as at night, without any specific activity.

When asked to describe their pains, people may describe them in different ways.

Some feel pain similar to cramps, while others feel more electric sensations.

How to relieve pain related to diabetic neuropathies?

Of course, an assessment with a healthcare professional is necessary to determine the things you can do in your situation to relieve your pains.

Some devices are completely useless despite the advertising, such as the Revitive Medic.

Physical therapy intervention may be relevant to assess your pains and the discomfort they cause in your daily life (difficulty sleeping, walking, etc.) as well as your other symptoms (loss of sensation in the foot, balance disorders, etc.).

Managing Diabetes

The main treatment for diabetes is glycemic control (blood sugar level). By controlling it, it is believed that one can reduce various diabetes-related symptoms, such as vision problems or diabetic neuropathy.

The doctor who oversees your diabetes management will define with you what is best to do in your case, based on your health status and lifestyle habits.

It is not necessarily necessary to adopt a strict diet; it is above all important to have a balanced diet and engage in regular physical activity.

The more people implement measures to limit their blood sugar levels, the later neuropathy appears and the less intense it is. This is especially true for type I diabetes but also for type II diabetes.

Moreover, being in hyperglycemia exacerbates pain.

Engaging in Physical Activity

Regular physical activity improves many health parameters, and pain is one of them.

Engaging in physical activity does not necessarily mean playing sports. Walking for a few tens of minutes a day, taking the stairs, gardening… all of these tasks can be considered physical activity.

It is necessary to engage in at least 30 minutes of moderate-intensity physical activity (meaning it makes us breathe a little faster and harder than at rest) 5 times a week to see its effects on health.

Although there are no studies directly linking physical activity to a decrease in pain in the case of diabetic neuropathies, it is reasonable to think that engaging in physical activity will help alleviate pain or limit its exacerbation.

A physiotherapist can also support patients with neuropathic pain by offering tailored physical exercises, especially in cases of muscle weakness or decreased balance capacity.

Using TENS

What is TENS?

TENS stands for Transcutaneous Electrical Nerve Stimulation. It is a device that delivers a harmless electrical current.

Electrodes are typically placed on the area you want to relieve, and then the device is activated.

A current is delivered. You can adjust its intensity: you should feel slight tingling sensations that are neither painful nor unpleasant.

If TENS is effective, it provides immediate pain relief, sometimes even between sessions. Several sessions per week, lasting about 20 to 30 minutes, can be performed.

TENS can be self-administered at home. It is not necessarily required to visit a physiotherapist.

However, it is advisable to seek medical or paramedical advice before starting TENS sessions to ensure there are no contraindications.

Several devices are commercially available and can be purchased online or at pharmacies. Prices start at around thirty euros for basic models.

See my comparative article on TENS devices for home use.

The electrodes need to be replaced regularly based on frequency of use.

TENS and Diabetic Neuropathy

There have been some studies that have investigated the effectiveness of TENS in patients suffering from pain related to diabetic neuropathy.

These studies were conducted on a small number of individuals (68 in total) and compared the effect of TENS to that of a “placebo” device, which did not deliver pain-relieving current.

Those who received TENS had less pain than others at 4 weeks and 6 weeks after the start of treatment, but not at 12 weeks. Patients also reported improvement in other symptoms of their diabetic neuropathy.

Although there is uncertainty about the effectiveness of TENS, as it is an easy-to-implement treatment, autonomously, with very few side effects, it is an option to consider.

Using Medication

Medications that can be taken to relieve pain in the case of diabetic neuropathy should be prescribed by a healthcare professional.

The most effective medications for relieving pain associated with diabetic neuropathies are those containing duloxetine at a dose of 60 to 120 mg per day.

Medications sometimes prescribed containing acetyl-L-carnitine are no more effective than placebos for pain after 6 or 12 months of treatment.

See also: side effects of Lyrica.

Opting for Surgery?

After failure of all other treatments (diabetes management, physical activity, TENS, medications), and pain related to diabetic neuropathy, surgery is sometimes proposed.

It involves decompressing the nerves in the lower limbs.

The effectiveness of this surgical technique is not proven.

Cannabidiol (CBD)

Many of my patients suffering from diabetic neuropathy and lower limb pain ask me about the benefits of cannabidiol (CBD) in their case.

I have written a detailed article on how CBD relieves neuropathic pain.

Indeed, the pain associated with diabetic neuropathy is neuropathic pain.

I invite you to refer to this article to form your own opinion on the benefits of CBD in your case.