Differentian between diabetic neuropathy and stenosis?

I hav been told after an exam and MRI's, that I have DDD, fibromyalgia, cervical and thoracic stenosis, and bulging disc at C4-5, T7-8, and a hemangioma at T-8. I also have had type 2 diabets diagnosed for 5 years. They did not do an EMG Study. How can I be sure it is diabetic neuropathy, and not pain from my spine? Would the treatment be different if the pain is from Spinal problems, then diabetic neuropaty? I am on 200mg of Lyrica, and Tramadol for pain. I need to increase the Lyrica, but side effects hinder me from doing so.

I am a 61 year old female. I find it increasinly hard to work a full week, but am a widow and my sole support. Catch 22...quit work for medical and try to get SSI, and starve. Or work and suffer debilitating pain. I sood for 4-5 hours yesterday, and last night and this am my leg pain is about a level 8.

Thank you for your time.

[Craig Brooker]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with your doctor.

While it can sometimes be a little tricky determining if there is 1 or multiple disease processes at work in a given patient, there are numerous items on history, exam, and imaging that helps neurologists understand which process(es) at work.  In your situation, for example, if you'd just a relatively serious injury to your back, your exam findings were consistent with those of spinal disease, your diabetes was very very well controlled, and your imaging studies were consistent with your exam findings for where the lesion was in your spine, then it would be highly likely the vast majority of your symptoms were from your degenerative disc disease.  You should be aware that "degenerative disc disease" is very very common in people your age.  The severity is widely variable and imaging not infrequently overestimates its severity (as many who have moderate to severe disease on imagining reports have little to no symptoms).

  Alternatively, if your diabetes is not well controlled (e.g. if your hemoglobin A1c is high), your neurological exam findings suggest disease related to your nerves in your muscles (and not your spinal cord or brain), and your degenerative disc disease is not very severe on imaging, this would all suggest your diabetes is the larger contributor.  If diabetes is thought to be the dominant contributor, controlling your diabetes is the most important thing for you going forward.  Lyrica (or any of a number of other medications) may help your symptoms, but they don't address the root cause of them).    In cases where there is a mixed picture, one certainly could get EMG to help clarify.  EMG is not inexpensive and most patients aren't particularly fond of the test itself so it's generally reserved for those needed further clarification.  

In terms of your struggles with your financial and work situation, it might be reasonable for you to get a consult with a social worker to see what options are available to you if you haven't already.  

[olivo]

I was very impressed with the answer you provided for the question posted by LLWB about the difference between Diabetic Neuropathy and Stenosis.
Although am not a diabetic I had very difficult time trying to get my EMG interpreted by my neurologist. My visits to his office are limited to little information and just a prescription with a bunch of medications.
At this time am visiting a chiro and a pain management doctor (she is an anesthesiologist) none of which are able to interpret the EMG results (thats what they say).
I wonder if there is a way or a place here where I can post my EMG test so you or anyone of the medhelp doctors can give me an opinion on it.
Have in consideration that I do have a test and it would be a stress release for me to at least understand what those graphic means.
If you can help me on this I would really appreciate it. I have it on a PDF form they are 11 pages.
Thank you Doc

[LLWB]

I don't know if the dr will return to review my question, thus leaving your's in limbo. You should try to post this question on your own thread.I think it's an important question, and deserves an answer. I know it's hard to post a question, it took me 3 days before this forum would accept the question. Good luck, I hope you can get an answer. It is so frustrating when dr's just hand out pills, and don't explain things. We the patients are the opnes dealing with these problems daily, I think we deserve more than we are getting from the medical profession.