Advances in the Diagnosis and Treatment of Painful Diabetic Neuropathy (original) (raw)
Related papers
Painful neuropathy and foot ulceration in diabetic patients
Diabetes Care, 1993
OBJECTIVE-To examine the prevalence of painful symptoms in neuropathic patients with or without foot ulceration. It has been suggested that there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recurrent foot ulceration.
An introduction to Diabetic Neuropathy: A Review
Diabetic neuropathy is the most frequent and devastating complication of diabetes mellitus leading to great morbidity and mortality, resulting in a massive financial burden for diabetes care. The prevalence of diabetic neuropathy ranges from 10% within one year of diagnosis of diabetes mellitus to 50% of patients with diabetes for greater than 25 years. Symptoms associated with large fibre damage include weakness, numbness, burning or tingling, and loss of balance, while those related with small fibre damage include pain, anaesthesia to pin and temperature sensation, and autonomic dysfunction. Chronic persistent hyperglycaemia is the key component and should not be overlooked because the progression of the disease may lead to diabetic foot. The objective of the article is to provide a detailed summary of definition, pathogenesis, classification, diagnosis and management of the patients with diabetic neuropathies. Good clinical history and complete physical examination including foot inspection to support the need for regular self-care are the basis of assessment followed by therapeutic and laboratory studies. Strict control of blood sugar is the single utmost preventive measure for diabetic neuropathy. Timely diagnosis and management of dyslipidaemia and hypertension, may aid to prevent, delay, or slow the development of diabetic neuropathy. Management of painful diabetic neuropathy includes tricyclic compounds, serotonin–norepinephrine reuptake inhibitors (e.g. duloxetine), antiepileptics (e.g. pregabalin), opiates, and physical therapies, the antioxidant alpha lipoic acid and topical medications.
Revista Dor, 2016
BACKGROUND AND OBJECTIVES: Diabetic neuropathy is a major cause of neuropathy worldwide and may lead to amputations and incapacity. This study aimed at a detailed and updated review on diabetic neuropathy, focusing on its classification, diagnostic investigation and treatment. CONTENTS: It is estimated that 371 million people aged from 20 to 79 years, worldwide, have diabetes mellitus and that at least half of them are unware of the diagnosis. Its prevalence in Central and South America was estimated in 26.4 million people, corresponding to approximately 6.5% of the population. Among microvascular complications, diabetic neuropathy is the most prevalent, leading to the highest rates of hospitalization, atraumatic amputations and incapacity. Diabetic neuropathy may have different clinical presentations, being distal symmetric polyneuropathy its most frequent presentation and major mechanism to the development of diabetic foot. Predominantly it presents with positive (burning, tingling) and negative (numbness, loss of sensitivity) sensory symptoms. In general it is associated to autonomic signs and symptoms and seldom there is motor manifestation. Approximately 20% of patients with distal symmetric polyneuropathy have neuropathic pain, which sometimes becomes chronic and disabling. CONCLUSION: Early and accurate diagnosis allows for adequate treatment , preventing progression of neuropathy and severe complications. For such, it is necessary to obtain an acurate clinical history, in addition to thorough neurological tests and additional tests, to identify signs of nervous fibers involvement. Its treatment depends on adequate glycemic control and neuropathic pain treatment, when present.
The prevalence of diabetic peripheral neuropathy and related factors
Iranian journal of public health, 2011
Diabetic peripheral neuropathy (DPN) accounts for 80% of diabetic foot ulceration; therefore neurologic examination plays a critical role in screening at risk patients. Our objective was assessment the prevalence of DPN and related factors based on clinical findings. This cross-sectional study was conducted on 124 diabetics who were randomly recruited from Diabetes Clinic of Dr. Shariati University Hospital (Tehran/Iran) in 2004. After gathering demographic data and blood sampling for fasting blood sugar (FBS), the questionnaires United Kingdom (UK), Michigan, Diabetic Neuropathy Score (DNS), and 10-g monofilament testing were administered. Analysis tests were chi-square, pearson correlation and logistic regression. The patient's age ranged 17-75 years; with 44% male. Ninety one percent suffered from type two diabetes and the mean duration of diabetes was 10 years. The mean FBS level was 181.5 mg/dl. While the prevalence of DPN based on Michigan, DNS, and monofilament testing wa...
Diabetic neuropathy and painful diabetic neuropathy: Cinderella complications in South East Asia
JPMA. The Journal of the Pakistan Medical Association, 2018
The most common and debilitating microvascular complication of diabetes is diabetic peripheral neuropathy (DPN), affecting 50-90% of people with diabetes. The major manifestations of DPN are painful (pDPN) and painless diabetic peripheral neuropathy. Painful symptoms, occur in the feet and are worse at night and whilst they alert both the patient and physician, are often misdiagnosed and mismanaged. The devastating presentation of painless neuropathy with loss of sensation is foot ulceration and Charcot foot. The explosion of diabetes, especially in the South East Asian (SEA) region will result in an increasing prevalence of both painful and painless diabetic peripheral neuropathy. PubMed, EMBASE, Medline and Google Scholar databases were searched between 1990 and 2017. This highlights the widely varying prevalence of DPN and pDPN in the World Health Organization (WHO) defined SEA countries and the dearth of published studies, especially in pDPN. We believe this will provide new dir...
Evaluation in Diagnosis and Management of Diabetic Neuropathy
Journal of Diabetes Mellitus, 2021
The 100-year anniversary of insulin is explored by focusing on diabetic neuropathy. Neuropathy is so common to diabetes, it is well described even in the earliest accounts of diabetes. This article reviews the most common neuropathy syndromes, and the consensus of effective treatment for neuropathic pain. Pharmacological advances in neuropathy are still largely focused on pain control, not neuropathy intervention. The article reviews the established and lesser tested therapies used for pain control. It also reviews the pathophysiology of the disease state, including the many factors and steps that culminate to produce neuropathy and its different iterations. In the future, new ways to treat diabetic neuropathy may be geared toward treating specific pathophysiological step-points on the way to nerve damage. In the future, prevention and a deeper look at the impact of socioeconomic status as a predictor of diabetes will hopefully encompass a bigger part of pre-diabetic care.
World Family Medicine Journal/Middle East Journal of Family Medicine, 2017
Background: Diabetes mellitus (DM) is becoming increasingly common in developing countries and is of major concern in the Middle East and North Africa (MENA). Since at least 30% of diabetic patients may develop painful diabetic peripheral neuropathy (pDPN) within their lifetime, there is an urgent need to increase awareness of the condition among physicians in the region. Objectives: To increase awareness of physicians in the Middle East and North Africa of the increasing prevalence of DM and pDPN and to provide practical consensus recommendations to facilitate the diagnosis and management of pDPN. Methods: A panel of family medicine physicians was convened in Dubai to discuss current awareness of pDPN in the region and to develop consensus statements based on a review of meta-analyses, systematic reviews, and evidence-based guidelines on the screening, diagnosis and management of pDPN. Recommendations: The panel recommends that all patients with diabetes be screened at least annually for symptoms of neuropathic pain using screening tools such as the Doleur Neuropathique en 4 Questions (DN4) as well as thorough examination of the patient's feet. Treatment should aim to achieve a clinically meaningful reduction in pain using first-line agents including pregabalin, duloxetine or tricyclic antidepressants. Conclusion: pDPN is common but under-diagnosed and inadequately treated in the Middle East and North Africa. Physicians in the region are encouraged to implement screening for pDPN and manage patients according to published guidelines.
Painful diabetic neuropathy: Diagnosis and management
Diabetes & Metabolism, 2011
The prevalence of painful diabetic peripheral neuropathy (PDN) is about 20% in patients with type 2 diabetes and 5% in those with type 1. Patients should be systematically questioned concerning suggestive symptoms, as they are not usually volunteers. As PDN is due to small-fibre injury, the 10 g monofilament pressure test as well as the standard electrophysiological procedures may be normal. Diagnosis is based on clinical findings: type of pain (burning discomfort, electric shock-like sensation, aching coldness in the lower limbs); time of occurrence (mostly at rest and at night); and abnormal sensations (such as tingling or numbness). The DN4 questionnaire is an easy-to-use validated diagnostic tool. Three classes of drugs are of equal value in treating PDN: tricyclic antidepressants; anticonvulsants; and selective serotonin-reuptake inhibitors. These compounds may be prescribed as first-line therapy following pain assessment using a visual analogue scale. If the initial drug at its maximum tolerated dose does not lead to a decrease in pain of at least 30%, another drug class should be prescribed; if the pain is decreased by 30% but remains greater than 3/10, a drug from a different class may be given in association.
A Review on Diabetic Peripheral Neuropathy
Journal of Drug Delivery and Therapeutics
Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and type 2 diabetes affecting over 90% of the diabetic patients. Due to the toxic effects of hyperglycemia there is development of this complication. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. Hence DPN is often inadequately treated, and the role of improving glycaemic control in diabetes. Major international clinical guidelines for the management of DPN recommend several symptomatic treatments. First-line therapies include tricyclic antidepressants, serotonin–noradrenaline reuptake inhibitors, and anti-consultants that act on calcium channels. Other therapies include opioids and topical agents such as capsaicin and lidocain...