Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy (original) (raw)
Related papers
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.
Practical Diabetes International, 2004
Painful diabetic neuropathy is a common and troubling complication of diabetes. Many current treatments are based on anecdotal reports or relatively small clinical trials in which the efficacy of the agents is questionable, reflecting the fact that none is specifically licensed for the management of painful diabetic neuropathy. Despite these limitations the authors provide a practical algorithm based on a number needed to treat analysis together with an assessment of drug safety. We advocate an improvement in overall glycaemic control together with a reduction in glucose flux, coupled with a stepwise approach starting with a tricyclic, followed by gabapentin, tramadol and carbamazepine. We do not recommend combination treatment. Copyright ©2004 John Wiley & Sons, Ltd.
Neurology, 2011
Objective: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). Methods: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; and non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" Results and Recommendations: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulphate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL. PM R 2011;3:345-352 Diabetic sensorimotor polyneuropathy represents a diffuse symmetrical and length-dependent injury to peripheral nerves that has major implications on quality of life (QOL), morbidity, and costs from a public health perspective [1,2]. Painful diabetic neuropathy (PDN) affects 16% of patients with diabetes, and it is frequently unreported (12.5%) and more frequently untreated (39%) . PDN presents an ongoing management problem for patients, caregivers, and physicians. There are many treatment options available, and a rational approach to treating the patient with PDN requires an understanding of the evidence for each intervention. This guideline addresses the efficacy of pharmacological and nonpharmacological treatments to reduce pain and improve physical function and QOL in patients with PDN. The pharmacological agents reviewed include anticonvulsants, antidepressants, opioids, antiarrhythmics, cannabinoids, aldose reductase inhibitors, protein kinase C beta inhibitors, antioxidants (alpha lipoic acid), transketolase activators (thiamines and allithiamines), topical medications (analgesic patches, anesthetic patches, capsaicin cream, clonidine), and others. The nonpharmacological modalities include infrared therapy, shoe magnets, exercise, acupuncture, external stimulation (TENS), spinal cord stimulation, biofeedback and behavioral therapy, surgical decompression, and intrathecal baclofen.
Polish Annals of Medicine, 2013
Introduction: Diabetes mellitus is gradually rising in global ranks of mortality and according to the World Health Organization it is estimated to occupy the seventh place by the year 2030. Diabetic neuropathy (DN) is the most common complication of diabetes and the symmetric distal polyneuropathy is its predominant form. Currently there are several clinical classifications of DN. Etiopathogenesis is presently the object of intense research and is yet to be fully comprehended. Aim: The purpose of this paper is to present and systematize the current state of knowledge on DN, in particular distal symmetric polyneuropathy. We hope that this would be helpful in the prevention, diagnosis and treatment of DN. Material and methods: It was based upon the available literature, publications and materials available in the online medical databases. Discussion: Prolonged exposure to hyperglycemia is recognized as the major mechanism and the risk factors include, among others, the degree of metabolic control of diabetes mellitus. Neuropathic symptoms result from the severity of nerve fiber damage. Nevertheless, in more than 50% of cases pain is the predominant symptom, which should encourage popularization of the use of quality of life questionnaires in diabetics. The primary and most important elements of causal treatment include the proper level of metabolic equalization, blood pressure normalization and cessation of stimulant use. Apparently the only drug influencing pathogenetic mechanisms is alpha-lipoic acid, efficiency of which has been confirmed in the ALLADYN and the SYDNEY trials. Conclusions: In light of the current state of knowledge, recommended first line medication in the treatment of pain associated with DN includes: tricyclic antidepressant, serotoninnorepinephrine reuptake inhibitor or antiepileptic drug. If monotherapy proves ineffective, adding a second drug may be considered, then adjuvant opioid and alternatively nonpharmacological treatment. In case of lack of response to treatment, stimulation of the spinal cord can be the final intervention.
An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy
Journal of Diabetes Research
Diabetes is the 4th most common disease affecting the world’s population. It is accompanied by many complications that deteriorate the quality of life. Painful diabetic neuropathy (PDN) is one of the debilitating consequences of diabetes that effects one-third of diabetic patients. Unfortunately, there is no internationally recommended drug that directly hinders the pathological mechanisms that result in painful diabetic neuropathy. Clinical studies have shown that anticonvulsant and antidepressant therapies have proven fruitful in management of pain associated with PDN. Currently, the FDA approved medications for painful diabetic neuropathies include duloxetine, pregabalin, tapentadol extended release, and capsaicin (for foot PDN only). The FDA has also approved the use of spinal cord stimulation system for the treatment of diabetic neuropathy pain. The drugs recommended by other regulatory bodies include gabapentin, amitriptyline, dextromethorphan, tramadol, venlafaxine, sodium va...
Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
Medicina
Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical ...
Treating Painful Diabetic Peripheral Neuropathy: An Update
2016
Painful diabetic peripheral neuropathy occurs in approximately 25% of patients with diabetes mellitus who are treated in the office setting and significantly affects quality of life. It typically causes burning pain, paresthesias, and numbness in a stocking-glove pattern that progresses proximally from the feet and hands. Clinicians should carefully consider the patient's goals and functional status and potential adverse effects of medication when choosing a treatment for painful diabetic peripheral neuropathy. Pregabalin and duloxetine are the only medications approved by the U.S. Food and Drug Administration for treating this disorder. Based on current practice guidelines, these medications, with gabapentin and amitriptyline, should be considered for the initial treatment. Second-line therapy includes opioid-like medications (tramadol and tapentadol), venlafaxine, desvenlafaxine, and topical agents (lidocaine patches and capsaicin cream). Isosorbide dinitrate spray and transcu...
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.