From the Guidelines
I strongly recommend reinstating your Tramadol and exploring alternative pain management options, such as gabapentin or pregabalin, to address your ongoing pain and discomfort after lumbar surgery. It appears that the recent discontinuation of your Tramadol and Baclofen, despite being renewed earlier this month, is likely contributing to your increased pain levels. The burning and tingling sensations in your legs and feet may be due to a combination of factors, including residual nerve inflammation from surgery, diabetic neuropathy (as Dr. Martinez mentioned), and possibly inadequate pain management 1. Diabetic neuropathy causes nerve damage that surgery cannot fix, but proper medication can help manage symptoms.
Possible Causes of Pain
- Residual nerve inflammation from surgery
- Diabetic neuropathy
- Inadequate pain management
Recommended Treatment Options
- Reinstating Tramadol and Baclofen
- Exploring alternative pain management options, such as:
- Gabapentin
- Pregabalin
- Serotonin-norepinephrine reuptake inhibitors (SNRIs)
- Sodium channel blockers
According to the American Academy of Neurology, gabapentinoids, SNRIs, and sodium channel blockers are recommended as initial pharmacologic treatments for neuropathic pain in diabetes 1. Additionally, a recent study suggests that tapentadol and Tramadol, which are centrally acting opioid analgesics, may be effective in treating pain in diabetic peripheral neuropathy, but their use should be approached with caution due to the risk of addiction 1.
Non-Medication Approaches
- Gentle stretching
- Applying ice/heat
- Avoiding prolonged sitting
Your post-surgical recovery combined with diabetic neuropathy requires comprehensive pain management, and your concerns about medication changes are valid and should be addressed promptly 1. It is essential to discuss your pain management options with your provider to determine the best course of treatment for your specific condition.
From the Research
Patient's Condition
The patient is a 57-year-old male who underwent lumbar L4-S1 surgery on April 02,2025, and is experiencing serious pain and discomfort. He is also experiencing burning and tingling sensations on the sides of his legs and feet due to severe damage to his sciatic nerve.
Medication Concerns
The patient's Tramadol and Baclofen medication was stopped, despite being renewed on April 16,2025. The patient is concerned about the discontinuation of these medications and would like to see a provider.
Diabetic Neuropathy
The patient has been diagnosed with diabetic neuropathy (Noropathy) due to his diabetes, and was informed by Dr. Martinez that surgery would not be able to fix this issue.
- The patient's symptoms, such as numbness, tingling, and pain in the extremities, are consistent with diabetic neuropathy 2.
- Studies have shown that intensive glycemic control with insulin may be associated with lower odds of distal symmetric polyneuropathy in patients with type 1 diabetes 3.
- First-line pharmacologic therapy for painful diabetic neuropathy (PDN) includes gabapentinoids (pregabalin and gabapentin) and duloxetine 3, 4, 5.
- Additional pharmacologic modalities, such as tapentadol and 8% capsaicin patch, are considered second-line agents and have shown modest treatment effects 3, 2.
- Non-pharmacological treatments, such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS), have also shown promise in reducing pain in patients with diabetic neuropathy 3, 2.
Treatment Options
The patient may benefit from alternative treatment options, such as:
- Pregabalin, which is established as effective for relief of PDN and has been shown to lead to a clinically meaningful improvement in pain scores 4, 5, 6.
- Other pharmacologic agents, such as venlafaxine, amitriptyline, and gabapentin, which are probably effective and should be considered for treatment of PDN 4, 5.
- Non-pharmacological treatments, such as SCS and TENS, which have shown promise in reducing pain in patients with diabetic neuropathy 3, 2.