Caudal epidural steroid injection as a novel therapy for treatment-induced neuropathy of diabetes in children: report of two cases.

Abstract

Objectives: Treatment-induced neuropathy of diabetes (TIND) is a rare complication of rapid glycemic improvement, characterized by severe shooting pain, predominantly in the lower extremities. This report aims to highlight the clinical presentation of TIND and evaluate the effectiveness of caudal epidural steroid injections (CESI) in managing refractory pain in pediatric cases.

Case presentation: We describe two pediatric cases of TIND following rapid improvement in glycemic control for type 1 diabetes. Both patients presented with debilitating pain and sleep disturbances that severely impacted their daily activities. Initial management with a combination of analgesics, pregabalin, gabapentin, and duloxetine failed to provide adequate relief. Subsequently, both patients received CESI with bupivacaine and methylprednisolone. Significant symptomatic improvement in pain and sleep was observed within 4-6 weeks post-intervention. At the 6-month follow-up, the pain relief was sustained, and no adverse effects were reported.

Conclusions: These cases underscore the importance of recognizing TIND as a potential complication of rapid glycemic control and the challenges in its management. CESI appears to be a promising therapeutic option for children with refractory TIND, offering durable pain relief and improved quality of life. Further studies are needed to validate its efficacy and safety in larger cohorts.