UT Southwestern launches study of surgical option for treating diabetic and othe

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UT Southwestern launches study of surgical option for treating

diabetic and other neuropathies

http://www.eurekalert.org/pub_releases/2008-07/usmc-usl070908.php

UT Southwestern Medical Center plastic surgeons and specialists in

diabetes, neurology, pain management and rehabilitation are launching

a cutting-edge study of peripheral nerve surgery to alleviate long-

standing pain and numbness in patients with diabetic neuropathy.

Neuropathy is nerve-related pain, often associated with diabetes. The

risk of developing neuropathy increases the longer a person has

diabetes, and it is estimated that up to 40 percent of diabetics have

some form of neuropathy. UT Southwestern is one of a few U.S. medical

centers, and the only facility in North Texas, to offer surgery on

peripheral nerves, which originate from the spine.

" Patients with neuropathy are often told that the problem is

irreversible and that they cannot be helped, " says Dr. Shai Rozen,

assistant professor of plastic surgery. " Diabetic neuropathy is a

complex problem caused by multiple factors. We think pressure on

nerves may be one component responsible for the symptoms in certain

patients. This is very important to emphasize: Surgery may be helpful

only in patients we suspect have pressure on their nerves in addition

to their neuropathy and is not for all neuropathy patients. "

About one-third of patients with diabetic neuropathy have overlying

compression of certain nerves in the leg that may worsen the pain and

cause loss of sensation at the bottom of the foot. Several studies

have demonstrated that the nerves may increase in diameter in

diabetic patients. In this study, UT Southwestern investigators are

hoping to show that by releasing pressure from the specific nerves of

these patients, pain may be decreased and sensation improved.

" The concept of nerve compression in diabetics is not new, " Dr. Rozen

said. " Carpal tunnel syndrome is a medical term used to describe

compression of the median nerve at the wrist. It appears in

approximately 2 percent of the general population, but in 15 percent

to 30 percent of patients with diabetes. The treatment of choice in

these patients, if conservative treatment has failed, is surgical

nerve release. "

In addition to pain, patients suffering from diabetic neuropathy have

decreased sensation on the bottoms of their feet. Because they can

injure their feet without noticing it, many develop ulcerations.

About one out of every six patients with ulcers require amputations –

accounting for the nearly 100,000 amputations per year in the U.S.

because of diabetes.

" If we are able to restore at least protective sensation – that means

patients will feel it if they hit something with their foot – it may

decrease the amount of ulcers and eventual amputations in this high-

risk population, " Dr. Rozen said.

Peripheral nerves supply sensation and are responsible for activating

different muscles in the body. If these nerves are injured or

compressed, they may be responsible for pain, loss of sensation, or

even loss of function. Some of these problems may be helped by nerve

surgery.

" Pain problems like these are not uncommon. The main problem is

education and awareness among patients and physicians alike that

there may be surgical solutions to some of these problems, " Dr. Rozen

said. " We all know patients who had surgery for a 'pinched' nerve in

the back. The concepts are very similar – relieve a nerve from

pressure, repair it or even cut it in certain cases, and the pain may

be relieved. "

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The study is funded through the Multidisciplinary Clinical and

Translational Pilot and Collaborative Study Initiative – Pilot Grant

Award Program and a gift from the Crowley Foundation