The first question I ask patients when they come to me with diabetic peripheral neuropathy is “Do you have trouble falling asleep due to your feet?” Often people with diabetic neuropathy have trouble falling asleep due to tingling and burning pain. The zingers may not be noticeable during the distractions of the day, but once settled into bed, the burning pain is obvious. Some patients struggle for hours to fall asleep, rubbing their feet together or getting out of bed to stand on the cold floor. If you share a bed, you may not be the only one losing sleep! Chronic fatigue can amplify the discomfort, leading to depression. It becomes a vicious cycle of pain and sleep deprivation impacting your quality of life.
The first thing we address with peripheral neuropathy is the nocturnal pain. Oral medications like gabapentin and Lyrica can be effective but have several systemic side effects; dizziness, dry mouth, clumsiness, or unsteadiness which can lead to a fall risk. Several OTC products are effective initially; menthol-based products like Biofreeze, lidocaine, capsaicin cream and Frankincense & Myrrh to name a few. The OTC ‘s may be less effective as the condition progresses over time.
I like to prescribe a topical compounded medication designed to calm over-excited nerves, block the pain signal, and decrease inflammation. The compound consists of anti-inflammatory, anesthetic and medication to address the nerves causing the neuropathic symptoms. The cream comes in pump and is applied twice daily, morning and night, to the sides and top of the right and left ankle with little to no systemic side effects. Daily inspection of the feet and ankles is a secondary benefit of topical application. If you cannot see your feet, you can feel if something is swollen or painful. I advise patients to wash their hands thoroughly after applying. If you cannot reach your feet, ask a partner or spouse to apply the medication. A second pair of eyes may pick up early signs of an ulcer or infection. A quick call to the podiatrist may head off trouble saving a trip to the emergency room. Patients usually find relief within 2-3 day. Sleep and neuropathy symptoms improve.
If you are experiencing diabetic peripheral neuropathy and are having trouble sleeping, schedule an appointment with Michele Kurlanski, DPM at Lighthouse Foot and Ankle Center. Dr. Kurlanski offers expert and professional podiatry services in Cumberland County, Maine. Please call us today at 207-774-0028 to schedule your appointment in our Scarborough office.
Sincerely,
Lighthouse Foot and Ankle Center Team
