Spinal Stenosis: A Cause of Nocturnal Neuropathic Pain

Spinal Stenosis: A Cause of Nocturnal Neuropathic Pain Exacerbation of nocturnal neur Exacerbation of nocturnal neuropathic pain is a recognized symptom of Diabetic Peripheral Neuropathy (DPN). Nocturnal symptoms are often worse after removing footwear and getting into bed, may or may not be well controlled with medication, and can disrupt sleep patterns.[br]Nocturnal exacerbation of neuritic pain can also be present in patients with spinal stenosis, with or without concomitant peripheral neuropathy, and may be related to sleep position. Extension position of the spine decreases the diameter of both the central spinal canal and lateral recesses, which may compress or otherwise affect nerves controlling sensation from the feet and legs. Altering sleep position can reduce or eliminate symptoms. Modifications include sleeping in a recliner, with a pillow underneath the thighs if sleeping on the back, between the thighs if sleeping on the side, or under the stomach transversely if sleeping on the stomach.[br]Five diabetic patients presenting with a diagnosis of DPN including nocturnal exacerbation of symptoms, who noted alteration of nocturnal symptoms by changing body position, who also had walking limitation secondary to neurogenic claudication (in the legs) or neurogenic positional pedal neuritis (in the feet), underwent [ldquo]positional testing[rdquo]. This involved both modification of sleep position, and full time use of a 3 or 4 wheeled rollator walker set to induce lumbosacral flexion, which may reduce or eliminate lower extremity symptoms of spinal stenosis. All had good to excellent improvement of nocturnal exacerbation. Two had elimination of all neuropathic symptoms suggesting that spinal stenosis was the sole problem. The remaining 3 had residual neuropathic symptoms that were eliminated with Monochromatic Infra Red Therapy, suggesting that DPN was also present.[br]Nocturnal exacerbation of neuritic pain, especially if affected by body position, or if accompanying a pattern of walking limitation improved with wheeled support (grocery cart or rollator walker), should lead to suspicion of spinal stenosis. In that positional testing is so easy to accomplish, this should be considered a primary approach in possible cases. Clinical use and further investigation of this approach are indicated STUART M. GOLDMAN 2138-PO Boca Raton, FL Complications - Neuropathy