h2g2 The Hitchhiker's Guide to the Galaxy: Earth Edition

I've been having a lot of trouble sleeping lately. Over the last month or two, the pain in my legs is so intense at night, that I wake on average every 1 1/2 hours, and can't find a comfortable sleeping position. I've been diabetic for 32 years, with Type 2 diabetes, and have had neuropathy for most of that time, but it's been very mild.

My question is this: While I've been given the tests to determine tactile sensitivity, I'm wondering if there's a way to determine if this pain is due to neuropathy, or due to something else? My doctor keeps calling it "just" neuropathy, so I'm puzzled that the former numbness is now pain, and damned inconvenient pain, at that!

I have no idea what diabetic neuropathy might be, but I have MS (causing neuropathy) so you have my deepest sympathy. I hope your GP can identify the cause and prescribe some suitable pain relief.

Hi SpaceCadette

Get your GP to arrange for circulatory tests - an angiogram to check that your peripheral circulation in your legs is OK.

Take a look here for neuropathy information - http://www.diabetes.co.uk/diabetes-complications/diabetes-neuropathy.html

and here for arterial disease - http://www.diabetes.co.uk/diabetes-complications/peripheral-arterial-disease.html

t.

turvy, I do have peripheral artery disease; it's made a bit worse, because I had a cardiac bypass surgery 5 years ago, and have had swollen ankles and leg fatigue ever since. It's the reason I'm on disability.

I'm getting very scared that this will lead to amputation. I've been walking as much as possible, and my legs hurt enough that I have to stop and rest every hundred feet or so. The night pain is worse than the walking pain, which just doesn't make sense to me. How can lying still be worse than plodding along?

This isn't medical advice to you of course.. (you can tell doctors on the internet because we don't give medical advice, whereas all other people seem to do it!).

One can tell usually tell arterial disease from neuropathy without the use of tests, just by taking a carefully history and a clinical examination.

Neuropathy causes pain, as the nerves get worse then they start sending messages saying 'pain' when there's nothing to stimulate them. The pain from neuropathy is often a different nature to pain from arterial disease. Pain from neuropathy is sometimes, burning and sometimes hot and cold, often shooting. It usually follows a certain distribution, described as 'glove and stocking'. you can detect the lose of sensation on examination. The pain is affected by temperature but not usually that much by exercise.

At first arterial pain happens right in your calf, whilst you're walking or running. Often after a a set distance, such as every time you walk 100 yards, then when you rest it stops. Eventually gradually it happens after 70 yards, then 50, etc etc.

If you have a patient with arterial disease you can often find that you can not clearly feel their pulses in their feet. These are usually still present in neuropathic pain.

Thanks, Z, for the info. It's actually the later, I'm afraid.

When I had the CABG (cardiac arterial bypass graft) 3, and they took veins from both legs. At one point, the discussion had been to get a stent put in, but since I've moved back to LA, my new HMO hasn't suggested any such thing.

I'm getting concerned as this interrupt-the-sleep pain seemed to spring up pretty quickly. Mostly it's ankle pain on the left, and the left side which contributed the most vein for the CABG.

Taking a vein from your leg wouldn't affect the arterial supply, it can mean that you leg gets more swollen, which leads to more pressure, which leads to more pressure on the nerves. So I guess it could make neuropathic pain worse.

What I had been thinking, though, is that with an impaired blood supply, the nerves would be more likely to hurt -- the diabetes is what affects blood flow, and poor blood flow would affect the nerves, and possibly cause pain.

Now that I've been back on Plavix (and ibuprofen for the pain), and massaging the calves before I go to bed, it's easing up a little. I only woke every 2-3 hours last night.