Peripheral neuropathy, the most common form of neuropathy, usually affects the legs and feet. The sensory nerves are affected by atrophy and loss of the longer peripheral nerve axons. Symptoms begin in the toes and move up. Typically, the disease affects both legs.
Easing Pain With Alternative Techniques
Patients with diabetic neuropathy may experience a wide range of pain and discomfort, from a mild annoyance that lasts only seconds or minutes to extreme pain that lasts for hours or days. Sometimes, mild analgesics can help relieve the pain-but not always. That's when your patient can benefit from nonpharmacologic techniques, such as guided imagery, meditation, and progressive relaxation therapy. To teach your patient these cognitive and behavioral techniques, you'll need her full cooperation.
Guided Imagery
Guided imagery, a form of hypnosis, requires your patient to use her imagination in a structured manner to achieve a desired effect. No one knows for sure how guided imagery works. It may simply distract patients from their pain, or it may trigger the release of endorphins by the anterior pituitary gland and hypothalamus, resulting in pain relief. The overall effect is that your patient becomes more relaxed, and her anxiety and blood pressure are reduced.
To perform guided imagery, your patient must concentrate on a pleasant mental image, such as a warm, sunny beach; a desirable feeling, such as comfort; or a pleasant event, such as winning the lottery. At first, you may need to help her by making suggestions. For example, you can ask her to imagine that she's lying on a warm, sunny beach and then describe some of the sights, sounds, and smells. Over time, your patient will learn to make her own mental connection with pleasant scenes and events.
For guided imagery to work, your patient must be able to concentrate for at least 5 minutes without distraction.
Meditation
When using guided imagery, you and your patient can participate together, but meditation is a solitary act. To meditate effectively, your patient must become self-focused and block out all distractions. This may be difficult to achieve in a noisy hospital environment. Meditation calls on a patient's ability to maintain inner control, effectively self-regulating her bodily functions. Some patients find music and chanting helpful, others rely on objects that provide a visual focus. Whatever the technique, many patients who use meditation achieve a level of relaxation and pain relief similar to that achieved with drugs.
Progressive Relaxation Therapy
Progressive relaxation therapy, a form of relaxation exercise, involves the sequential tightening and relaxing of various muscle groups. As with guided imagery, you can help your patient relax and relieve pain by guiding her through the exercise. Furthermore, you can teach your patient's caregiver how to perform this technique.
For best results, the room should be quiet, free from distractions and dimly lit. You must first help your patient become quiet and relaxed so that she's receptive to your instructions. Using a soothing voice and playing soft music may help. Then, ask your patient to focus on one muscle group, for example the muscles in her left thigh. Ask her to tighten these muscles with all of her strength and then after several seconds to release and completely relax them. Repeat this procedure with all muscle groups. As this therapy progresses, the patient not only becomes distracted from her pain but also achieves muscular relaxation and in many cases goes to sleep.
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Diabetic Neuropathy
