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Diabetic Neuropathy

About Diabetic Neuropathy

Neuropathy refers to damage to the nerves in the peripheral nervous system. While it can be caused by some other illnesses, most cases of neuropathy are caused by diabetes. Diabetic neuropathy has been known to affect up to 50% of diabetic patients in the course of their illness, there is no clear route of treatment for this condition.

What Causes Diabetic Neuropathy

Diabetic neuropathy is caused by high blood sugar (glucose) in the body which damages the nerves. There are four main types of diabetic neuropathy.

Peripheral Symmetric Neuropathy
Peripheral neuropathy affects the outer parts of the body. It is felt towards the extremities such as the legs or the hands. The most common symptom is a sense of numbness or pain in the foot. Some may also feel an increased sensitivity to touch or have serious foot problems such as joint pain and infections.
Autonomic Neuropathy
Autonomic Neuropathy affects the autonomous nervous system. It is felt in the organs that control involuntary functions such as bowel movement, sexual response, blood sugar level awareness, sweat glands or the nerves of your pupils. In each of these affected areas, the effect is determined by the affected organ, which could be the stomach, sexual organs, intestines, skin, or eyes.
Thoracic and lumbar root/Proximal Neuropathy
Thoracoabdominal neuropathy affects the thoracic area of the spine. It damages the nerves along a specific area of distribution. Symptoms are a loss of strength in the legs or pain in the thighs, hips and butt.
Mononeuropathies/ Focal Neuropathy
Mononeuropathy is damage to a single nerve. It is further subdivided into cranial and peripheral. Cranial mononeuropathy causes double vision and paralysis on one side of the face numbness, while peripheral mononeuropathy causes tingling in your fingers or weakness in your hands.

Symptoms Of Diabetic Neuropathy

Each of these forms of neuropathy is not exclusive and can occur together, numbness in the foot area is usually caused by mononeuropathy and peripheral neuropathy. It can be particularly dangerous as small cuts or injuries at the foot may be left unnoticed due to the numbness, therefore, it is important to check for any infections and injuries if you have neuropathy.
The pain experienced from neuropathy can be felt in any part of the body, for example, thoracic radiculopathy causes pain in the ribs and the abdomen while peripheral neuropathy causes pain in extremities such as the foot.
TendernessLeg Weakness
Patients will experience leg weakness, especially after an exercise or when climbing the stairs.

Diagnosing Diabetic Neuropathy

Determining the source of the pain is essential to recommend the right method of treatment and rehabilitation. Here at Singapore Paincare, our team of experienced primary care and specialist pain care doctors will conduct a thorough diagnosis. This includes a physical exam, questions about your symptoms and an evaluation of your medical history. An X-ray or MRI scan and a nerve conduction test may be needed to evaluate or confirm the degree of diabetic neuropathy.

A Message About Diabetic Neuropathy

The numbness in the feet can extend from the toes up to the ankles, including the entire foot. This numbness is persistent throughout the day regardless of movement or activity. This unpleasant numbness can affect activities of daily living such as standing and walking – giving a sense of poor proprioception and unsteadiness as well as sleep. The discomfort in the feet can affect sleep or interrupt the quality of sleep. It is often associated with a sense of coldness in the feet, not responding to heat or wearing socks. This is a nerve type pain due to nerve injury from high blood sugar exposure.

This neuropathy can be treated with a nerve stabilizer such as anti-convulsants to reduce the sensitivity of the feet. It may need long-term management to titrate the effects of the nerve stabilizer accordingly. Contrary to beliefs, once neuropathy sets in, control of blood sugar levels will not reverse the numbness in the feet. While it is good to keep an eye on the hypocount (glucose meter) number, we will need to add on other specific treatments for this nerve injury type pain.

What Treatments Are Available for Diabetic Neuropathy

Diabetic neuropathy treatment focuses primarily on lowering blood sugar levels and treating pain. At Singapore Paincare, we strive to treat your pain with the least invasive option possible after accurately identifying the cause. Combined with pharmacological treatments and cognitive and physical rehabilitative therapies, we help patients improve functions and prevent pain from recurring.

Non-Surgical Treatment for Diabetic Neuropathy

Generally, pain killers are not helpful with nerve injury type pain. Apart from NSAIDS, our physicians and specialists will monitor and infuse anti-convulsants and serotonin-norepinephrine inhibitors into patients if suitable. These drugs reduce the painful symptoms of neuropathy. Other drugs include anticonvulsants, tricyclic antidepressants or even opioid pain relief medication in severe cases.
Upon review by our specialists, a variety of specially designed exercises can improve the elasticity, strength and support of the feet and ankles. Muscle exercise can also reduce pain and prevent damage from worsening.
Electrotherapy Treatments (TENS)
Applications of heat and cold and transcutaneous electrical nerve stimulation (TENS) are offered by our doctors, these methods treat the pain by blocking the nerve transmission.

Surgical Treatments for Diabetic Neuropathy

Diabetic Neuropathy can only be managed by a few methods. When weakness appears and treatments are ineffective, surgery may be needed. As surgery always comes with associated risks, complications and downtime – it may not be suitable for everyone.

Nerve Decompression surgery may be done to treat other radiculopathy or nerve compression syndrome, but not for peripheral neuropathy. Spine surgeries are used to relieve spinal stenosis caused by certain nerve impingement syndrome.

How Can I Prevent Diabetic Neuropathy?

You can reduce your risk of diabetes complications and diabetic nerve pain by:

  • Limiting alcohol intake
  • Eating a healthy and balanced meal
  • Regular exercises
  • Quitting smoking
  • Regular health check-ups with your doctor

On the other hand, if you have diabetes, it’s important to manage your:

  • Blood pressure
  • Blood sugar
  • Cholesterol

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