Does Peripheral Neuropathy Get Worse If Left Untreated?

Does peripheral neuropathy get worse if left untreated?

Peripheral neuropathy is a tricky condition, and patients who are familiar with its mysterious ways of coming and going and changing can attest to the difficulty of finding meaningful treatment to mitigate its painful symptoms.

Most people who experience peripheral neuropathy for the first time are caught off guard when the tingling, burning, and numbness start moving into their fingers and toes. Unfortunately, many patients don’t know the causes of these symptoms and haven’t been fully educated. Many patients do not know how their progressive diabetes relates to the sensations that manifest in their extremities. 

They don’t often know that high blood sugar that, combined with other issues including insulin resistance, effectively damages the nerves and causes them to “short-circuit” and send a variety of signals such as pain, burning, tingling, and numbness when no external cause is present. 

Lack Of Education About The Symptoms of DPN

It is perhaps due to the lack of education on diabetic peripheral neuropathy (DPN), that patients do now know where to turn for treatment or what they should do to mitigate the symptoms. 

Often, when patients are faced with the conditions of DPN, the first thing patients turn to is rubbing and massaging the affected area and if the pain increases, they turn to nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and Tylenol to dampen the pain. 

While NSAIDs are an effective short-term way to lessen the pain, their effect is temporary and they are compounded with other unwanted side-effects, as well as the effective dose wearing off over time making it harder to obtain relief using NSAIDs.

However, massaging the areas affected by diabetic peripheral neuropathy will not help with the tingling and pain because the pain is not due to the stressing of muscles in the hands and feet but the damage to the peripheral nerves in those areas from internal issues like metabolic conditions and medications being taken to treat other conditions. 

Many patients are understandably frustrated with the symptoms and the seemingly unknown or unexpected onset. Many doctors do not have the time, or unfortunately the patience, to explain the condition in a cohesive way that will help patients understand their responsibility and ability to mitigate the condition while they seek effective treatment. 

However, what happens when patients– either due to a lacking education or stubbornness– let their DPN go untreated?

Consequences of Untreated Peripheral Neuropathy

Numbness, tingling, and pain are the telltale signs that one or more parts of the peripheral nervous system have been affected by nerve damage. But, if left untreated, the outlook for diabetic peripheral neuropathy (DPN) can vary – from causing debilitating pain to leading to ulcers and limb amputation – depending on which nerves have been affected.

Although addressing the underlying cause of DPN patients can limit nerve deterioration, it is important to be aware of the complications and consequences of untreated peripheral neuropathy, including the ones below:

• Worsening of symptoms: If left untreated, diabetic peripheral neuropathy can lead to persistent discomfort, which becomes more noticeable at night. If motor nerves (the ones controlling the movements of limbs) are affected, patients might also start noticing problems with balance and coordination, as well as slower reflexes. 
• Unfamiliar or unusual sensations: When the nerves responsible for transmitting signals to the brain are damaged, patients might be over-sensitive to external stimuli (i.e.: experiencing pain when performing actions that are normally painless), feel unusually hot or cold or become desensitized to pain. 
• Weaker connected muscles and paralysis: If synaptic connections (or the region where muscles and nerves communicate) are affected by neuropathy, motor signals from the brain are inhibited. This causes the connected muscles to weaken and become unresponsive. Over time, this can lead to muscle weakness and, in severe cases, muscle atrophy or paralysis, especially in the body’s lower extremities.
• Affected autonomic processes: Neuropathy can affect nerves in the autonomic nervous system, or the nerves in charge of controlling involuntary physiologic functions, such as heart rate, respiration, and digestion. If this happens, patients might require treatment and medical devices, such as pacemakers. 
• Foot ulcers and infections: Neuropathy can stop pain signals from reaching the brain, which translates into the inability to detect painful stimuli. In turn, even a small wound caused by using inadequate footwear can become infected and lead to gangrene, ulceration, and tissue breakdown. Foot ulceration due to diabetic peripheral neuropathy affects a quarter of people with diabetes and neuropathy and accounts for 50-75% of non-traumatic amputations.

In short, the consequences of untreated peripheral neuropathy are increased severity symptoms of peripheral neuropathy and eventual amputation– especially of the feet. Patients should be made aware of their DPN’s ability to permanently damage the nerves in their extremities and render those extremities useless. 

In the case of medication induced neuropathy the symptoms may remain or get worse as well. Perhaps the most unfortunate risk factor of increased diabetic peripheral neuropathy is the presence and longevity of the condition itself.

The Importance Of Early Detection And Screening For DPN

A recent study conducted by doctors Xiuxiu Liu and Yuyan Xu in 2019 found that, “DPN’s prevalence increases with the duration of the disease. 

The results of this study showed that the duration of disease had a statistically significant effect on the complications of peripheral neuropathy in patients with type 2 diabetes. This is consistent with previous research results suggesting that early screening for primary disease is important to prevent and delay the occurrence of DPN”. 

But how do patients or doctors prevent these things from happening? How does early screening delay the occurrence of diabetic peripheral neuropathy and how can early detection help patients mitigate the condition and its symptoms?

The Early Stage Is The Most Critical

Doctors Liu and Xu conclude in their study that, “ . . . DPN is extremely difficult to treat, determining its risk factors and controlling it at an early stage is critical to preventing its serious consequences and the burden of social disease”. 

The issue for most physicians and their patients who suffer from DPN is that the lack of treatment for peripheral neuropathy makes “controlling” it, when it manifests in patients with diabetes, extremely difficult. What are doctors Liu and Xu referring to when they say we must determine the risk factors and control it before the serious consequences occur?

Risk Factors Associated To DPN

With neuropathy being a co-morbidity in 51% of diabetic patients, diabetes remains the first cause of peripheral neuropathy. Nonetheless, the severity and duration of neuropathy, as well as the likelihood of complications, depend on certain risk factors – most of which can be adequately managed from the early stages of the disease. 

Some of the variables that impact a patient’s level of risk of reporting severe nerve damage include:

• Duration of diabetes: A diabetic patient’s risk of developing neuropathy increases alongside the duration of their diabetes, especially if blood sugar isn’t properly managed. A 2014 study shows that the risk of diabetic peripheral neuropathy increased from a baseline of 6% to 30% in 13 years among patients with type 1 diabetes. 
• Poor glycemic control: Poorly managed blood sugar is a major risk factor for most complications in diabetic patients, including retinopathy, nephropathy, and neuropathy. Indicators of inadequate glycemic control include high levels of fasting plasma glucose and the percentage of red blood cells with sugar-coated hemoglobin, tested with the HbA1c test.
• Being overweight: Patients with a Body Mass Index of 25 or above are at greater risk of developing diabetic complications. This is because excessive fat releases fatty acid and glucose into the bloodstream, which reduces insulin sensitivity and makes it more difficult to manage blood sugar. 
• Age: Older patients have greater chances of having lived with diabetes for longer. Additionally, aging contributes to the deterioration of nerve fibers and leads to complications such as loss of balance and coordination.
• Smoking: Smoking and nicotine exposure alone can damage nerves. But, in diabetic patients, it can also worsen neuropathy and lead to ulcers by deteriorating arteries, reducing blood flow, and delaying wound healing. 
• Kidney disease: Inhibited kidney function, which can be assessed via blood urea nitrogen tests, is a common complication of diabetes that causes accumulated nerve-damaging toxins and waste materials to be released into the bloodstream. Additionally, imbalances in the levels of electrolytes in the body can affect how nerve cells work, thus leading to uremic neuropathy.
• Diabetic retinopathy (DR): In diabetic patients, neuropathy and retinopathy are often connected. A study showed that patients with DPN were 1.3 times more likely to develop Diabetic Retinopathy. Additionally, those with Diabetic Retinopathy, which causes microvascular damage to the retina, are at higher risk of reporting nerve damage in the same area, known as retinal diabetic neuropathy.

Risk factors for diabetic peripheral neuropathy are perhaps key indicators to the severity of the condition. According to doctors Liu and Xu, risk factors for severe DPN include, “the duration of diabetes, age, HbA1c, DR, smoking, and BMI, fasting plasma glucose (FPG), blood urea nitrogen (BUN), [and] diastolic blood pressure . . .”. 

These risk factors for increased severity in DPN are what doctors Liu and Xu seek to educate their patients about. What doctors seek to maintain between themselves, and their patients is the ability to control these risk factors in order to mitigate the likelihood of increased, severe peripheral neuropathy.

How Can A Patient Help Mitigate Risks

There is no denying that diabetes is a complex condition that, over time, affects several processes and bodily functions which, in turn, can lead to a cascade of consequences – not excluding neuropathy. 

Nonetheless, when looking at the risk factors that are likely to cause severe nerve damage in people with diabetes, a pattern emerges: most of the variables above can be adequately managed through lifestyle changes, preventive therapies, and ad hoc treatments. 

Ultimately, when it comes down to managing the burden of diabetes and diabetic peripheral neuropathy, a major role is played by healthcare professionals and their ability to educate patients to gain more control over their health.

For these doctors, treatment of DPN includes the patient’s ability to maintain their diabetes, avoid smoking, and control their BMI (body mass index). However, while other risk factors such as age are of course uncontrollable, this does not make the unchangeable factor of increased age any less of a risk factor for increased DPN. 

Doctors like Liu and Xu would do well to educate their patients on their ability and responsibility to mitigate these risk factors through their own actions and explain that the choices they make for their health are indeed a major part of the treatment for DPN. 

Some of the most impactful guidelines healthcare professionals should provide their patients with include the following ones:

Control Their BMI (Body Mass Index)

A patient’s Body Mass Index (BMI) is a critical indicator of their likelihood of developing a range of conditions, including hypertension, heart disease, and high mortality. 

In particular, a BMI above 25 or 30, which indicates being overweight and obese respectively, is a significant risk factor for diabetes. For those with a BMI of 35 and above, the risk of diabetes is 93 times higher than in those within a normal weight range. 

Beyond simply increasing the chances of developing diabetes, a high BMI makes complications such as severe diabetic peripheral neuropathy more likely. In 2019, a study found a direct correlation between fat mass, fat percent, visceral fat area, and the prevalence of neuropathy in adults with diabetes. 

Because of this, it is of paramount importance that healthcare professionals educate diabetic patients about the importance of maintaining a healthy weight. For those who are overweight or obese, a nutritious and balanced diet aimed at controlling calorie intake, coupled with regular exercise, should be the first port of call to reduce the likelihood of severe nerve damage.

Manage And Maintain Diabetes

As seen above, the duration of diabetes and how well blood sugar levels are managed are directly correlated to how likely a diabetic patient is to report nerve damage. This is because, over time, uncontrolled blood sugar can damage the blood vessels responsible for delivering essential nutrients to peripheral nerves. 

To delay the onset of diabetic peripheral neuropathy or manage possible complications, it is crucial for patients to adequately manage blood sugar levels through proper nutrition, exercise, and healthy lifestyle choices.

Avoid Smoking And Alcohol

Exposure to nicotine can have a profound impact on all aspects of a diabetic patient’s health. Firstly, smoking can inhibit the circulatory system and reduce blood flow, which prevents nerve cells from accessing essential nutrients and oxygen. 

Additionally, smoking can affect how the body processes blood sugar, thus contributing to poor glycemic control, which can lead to the side effects seen above. 

Lastly, in diabetic patients with neuropathy, smoking can increase the risk of developing ulcers by interfering with the body’s ability to heal wounds and suppress infections. 

Alcohol, especially if consumed excessively over long periods of time, can have a just as detrimental effect. Diabetic patients diagnosed with alcohol use disorder are at greater risk of developing what’s called alcoholic neuropathy, or damage of the myelin coating (the insulating and protective sheath that coats the nerves). 

Alcohol also makes it harder to control blood sugar levels and even leads to nutritional deficiencies. For patients battling a smoking habit or an active alcohol abuse disorder, the first step to avoiding the complications of neuropathy is to make healthier choices and seek adequate lifestyle counseling.

Eat A Healthy And Balanced Diet

Nutrition is at the core of regenerative and lifestyle medicine – and for more than one reason. Through proper nutrition, diabetic patients can better manage blood sugar, reduce the volume of toxins nerves are exposed to, and support the immune system. 

Additionally, a well-rounded diet can prevent nutritional deficiencies that have been seen to contribute to nerve damage – like in the case of vitamin B12, the lack of which can lead to temporary or permanent sensory and motor nerve damage.

Helping diabetic patients follow a healthier and more balanced eating regime can also contribute to reducing the prevalence of obesity and the complications of this chronic condition.

How Relatyv Treats The Symptoms Of Peripheral Neuropathy

Regardless of the prevalence of diabetic peripheral neuropathy in patients or their journey in treating their condition with the advice of their doctors, Relatyv offers a unique treatment for the symptoms associated with peripheral neuropathy such as pain, tingling, burning, and numbness from the condition, as well as an effort to restore health and magnify quality of life through relieved pain and restores health. 

The treatment program is called Neuralgesia and is a combination of electroanalgesia and specialized hydration therapy to reduce ion concentrations in the affected inflamed tissues. 

Hundreds of patients have experienced relief from the pains and irritations of peripheral neuropathy through the Neuralgesia treatment protocols. Patients who may have been wary of taking medication or undergoing expensive surgery to alleviate their symptoms, can instead relieve pain, restore health, and magnify quality of life through the proprietary Relatyv Neuralgesia therapy protocol.

The Neuralgesia Treatment Program

Many patients experience immediate relief and regain function in their extremities after only a few treatment sessions. 

Relatyv uses FDA cleared electroanalgesia technology to deliver high pulse-per-second electrical current deep into the tissues that stimulate tissue responses and activate dormant or underactive tissues and restore the peripheral nerves tissue that has been damaged from ongoing metabolic conditions causing peripheral neuropathy. 

This proprietary Neuralgesia treatment program is not only used to treat the effects of peripheral neuropathy but many other chronic pain conditions such as, back pain, knee pain, joint pain, fibromyalgia, migraines, post-op pain stemming accidents or surgery, and a wide range of chronic pain conditions. 

A study done by Clarence Cone, MD, PhD at the University of Virginia found that the electroanalgesia technology, applied in the proprietary Neuralgesia treatment protocol used by Relatyv has been proven to increase the presence of small neural fibers. 

A patient who experiences the growth of these fibers will likely experience less pain from peripheral neuropathy and many other painful conditions. Neuralgesia treatment sessions with Relatyv often result in immediate and long-lasting solutions to the conditions of peripheral neuropathy. 

Patients express effective relief from the pain but also the peace of mind that they do not need to rely surgery, invasive procedures or implants, or on potentially addictive medications that have mind-numbing and detrimental side-effects.