865 NEUROPATHIC PAIN CHARACTERISTICS IN GASTROPARESIS: LOSS OF PROTECTIVE SENSATION TO SOMATIC STIMULATION GREATER IN IDIOPATHICS VERSUS DIABETICS

2021 ◽  
Vol 160 (6) ◽  
pp. S-178-S-179
Author(s):  
Braden Kuo ◽  
Helen Burton Murray ◽  
Emily P. Sharkey ◽  
Robert Edwards ◽  
Richard W. McCallum ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Pain Characteristics ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Biomechanical Properties of the Foot Sole in Diabetic Mellitus Patients

2014 ◽  
Vol 3 (1) ◽  
pp. 1-17 ◽  
Author(s):  
V. B. Narayanamurthy ◽  
Richa Poddar ◽  
R. Periyasamy
Keyword(s):  
Pressure Distribution ◽  
Biomechanical Properties ◽  
Distribution Parameter ◽  
Diabetic Patients ◽  
Ulcer Formation ◽  
Wear Properties ◽  
History Of ◽  
Protective Sensation ◽  
Index Value ◽  
Loss Of Protective Sensation

This aricle evaluates and quantifies the biomechanical properties of the foot sole like – loss of protective sensation, hardness of the foot sole and pressure distribution parameter called Power ratio (PR) and its alterations, which have a direct effect on ulcer formation. A new parameter PRS Index is developed to understand the interplay between these parameters and its role in ulcer formation. All diabetic subjects attending the Diabetic foot clinic from Dec2003 to June 2007 undergo a standard foot examination.A total of 652 diabetic patients including 57 ulcer patients are taken for our study. The biomechanical properties include loss of protective sensation (LOPS) which is measured by 10 gm Semmes Weinstein Monofilament (SWMF). Hardness of the foot sole or absence of suppleness is tested using the Durometer (ASTM-D 2240 standards). Plantar pressure measurement is done using the PedoPowerGraph(p) which measures pressure distribution parameter PR. Foot wear properties like hardness of the insole affecting the formation of plantar ulcers was also measured. The above mentioned important parameters can be measured objectively and calculate PRS index value for diabetic with history of previous ulcer patients. We found a single entity of either the PR or shore independently cannot predict the risk for ulcer formation.In this study we found newPRS index value for diabetic with history of previous ulcer patients show significant correlation (i.e. p<0.05 level) between footwear shore and PRS index for history of previous ulcer patients. No significant correlation was shown for diabetic without history of previous ulcer patients and this may be due to diabetic patients are wearing footwear randomly with different degree Shore. From the case studies we found that the PRS index values and other biomechanical parameter of the foot sole can be reversed if the patients wear proper MCR footwear with 20 degree Shore. Use of appropriate footwear has shown that these easily measurable parameters and thus prevent ulcer formation as mentioned in the earlier studies. Several methods are used previously for predicting ulceration in DM patients. But in this study the new index PRS was studied and its role in predicting ulceration. Use of appropriate footwear will reverse the hypertrophic response; this can be quantified by the PRS index. We have found that there is decrease in PRS index by proper off loading the pressure using 20-degree shore MCR footwear.

The Safety and Effectiveness of the Percutaneous Flexor Tenotomy in Healing Neuropathic Apical Toe Ulcers in the Outpatient Setting

2019 ◽  
Vol 13 (2) ◽  
pp. 123-131
Author(s):  
Simon E. Smith ◽  
Julie Miller
Keyword(s):  
Patient Satisfaction ◽  
Ulcer Healing ◽  
Case Series ◽  
Outpatient Setting ◽  
The Mean ◽  
Prospective Case Series ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Mean Time ◽  
Flexor Tenotomy

Percutaneous flexor tenotomy is a minimally invasive procedure that involves cutting one or both flexor digitorum tendons underneath the toe. It is an alternative to open surgical procedures performed in an operating theatre. This project is a prospective case series investigating the utility, effectiveness, and participant satisfaction of the percutaneous flexor tenotomy when performed in the outpatient setting. People with diabetes, digital flexion deformity, and loss of protective sensation with an apical ulcer or preulcerative lesion presenting to the Austin Health Foot Ulcer Specialist Outpatient Clinic were enrolled in the study. The procedure was performed under sterile technique with an 18-gauge needle or fine scalpel blade. Participants were reviewed weekly until the incision and/ or ulcer healed. Participants were then followed up at 3 and 6 months. Time to ulcer healing, reulceration rate, frequency of complications, and patient satisfaction were recorded. There were 11 toe ulcers and 41 preulcerative lesions. A total of 76 tenotomy procedures were performed on the 23 participants across 35 episodes of care. The mean time to ulcer healing following tenotomy was 10.2 ± 4.3 days. There were no recurrences of ulceration. The infection rate per episode of care was 2.8%. There were 11 toes (14.5%) that sustained a transfer lesion post the index procedure. The mean time to development of a transfer lesion was 95.5 ± 98.1 days. All participants strongly agreed that they were satisfied with the outcome of the procedure. The flexor tenotomy is an effective procedure to expedite the healing of apical toe ulcers in people with loss of protective sensation and flexion digital deformity. It has a low infection rate and high patient satisfaction rate when performed in the outpatient setting. There is a moderate risk of transfer preulcerative lesions to an adjacent digit. Levels of Evidence: Level IV: Prospective case series

Improved Sensitivity in Patients with Peripheral Neuropathy

2005 ◽  
Vol 95 (2) ◽  
pp. 143-147 ◽  
Author(s):  
Salvatore L. DeLellis ◽  
Dale H. Carnegie ◽  
Thomas J. Burke
Keyword(s):  
Diabetes Mellitus ◽  
Risk Factor ◽  
Peripheral Neuropathy ◽  
Diabetic Foot ◽  
Medical Records ◽  
Significant Clinical Improvement ◽  
The Mean ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Foot Sensation

The medical records of 1,047 patients (mean age, 73 years) with established peripheral neuropathy were examined to determine whether treatment with monochromatic infrared photo energy was associated with increased foot sensitivity to the 5.07 Semmes-Weinstein monofilament. The peripheral neuropathy in 790 of these patients (75%) was due to diabetes mellitus. Before treatment with monochromatic infrared photo energy, of the ten tested sites (five on each foot), a mean ± SD of 7.9 ± 2.4 sites were insensitive to the 5.07 Semmes-Weinstein monofilament, and 1,033 patients exhibited loss of protective sensation. After treatment, the mean ± SD number of insensate sites on both feet was 2.3 ± 2.4, an improvement of 71%. Only 453 of 1,033 patients (43.9%) continued to have loss of protective sensation after treatment. Therefore, monochromatic infrared photo energy treatment seems to be associated with significant clinical improvement in foot sensation in patients, primarily Medicare aged, with peripheral neuropathy. Because insensitivity to the 5.07 Semmes-Weinstein monofilament has been reported to be a major risk factor for diabetic foot wounds, the use of monochromatic infrared photo energy may be associated with a reduced incidence of diabetic foot wounds and amputations. (J Am Podiatr Med Assoc 95(2): 143–147, 2005)

scholarly journals Association between Neuropathic Pain Characteristics and DNA Methylation of TRPA1 in Human Peripheral Blood

2019 ◽  
Author(s):  
Shiho Takenaka ◽  
Norihiko Sukenaga ◽  
Mai Imasaka ◽  
Masaki Ohmuraya ◽  
Yuka Matsuki ◽  
...  
Keyword(s):  
Dna Methylation ◽  
Chronic Pain ◽  
Neuropathic Pain ◽  
Peripheral Blood ◽  
Transient Receptor Potential ◽  
Cpg Island ◽  
Human Peripheral Blood ◽  
Chronic Pain Patients ◽  
Pain Characteristics ◽  
Pain Patients

Background: Elucidation of epigenetic mechanisms correlating with neuropathic pain in humans is crucial for the prevention and treatment of this treatment-resistant pain state. In the present study, associations between neuropathic pain characteristics and DNA methylation of the transient receptor potential ankyrin 1(TRPA1) gene were evaluated in chronic pain patients and preoperative patients. Methods: Pain and psychological states were prospectively assessed in patients who suffered chronic pain or were scheduled for thoracic surgery. Neuropathic characteristics were assessed using the Douleur Neuropathique 4 (DN4) questionnaire. DNA methylation levels of the CpG island in the TRPA1 gene were examined using whole blood. Results: Forty-eight adult patients were enrolled in this study. Increases in DNA methylation rates at CpG -51 showed positive correlations with increases in the DN4 score both in preoperative and chronic pain patients. Combined methylation rates at CpG -51 also significantly increased together with increase in DN4 scores. Conclusions: Neuropathic pain characteristics are likely associated with methylation rates at the promoter region of the TRPA1 gene in human peripheral blood.

Symptomatic Reversal of Peripheral Neuropathy in Patients with Diabetes

2002 ◽  
Vol 92 (3) ◽  
pp. 125-130 ◽  
Author(s):  
Alan B. Kochman ◽  
Dale H. Carnegie ◽  
Thomas J. Burke
Keyword(s):  
Peripheral Neuropathy ◽  
Near Infrared ◽  
Diabetic Patients ◽  
Cold Sensation ◽  
Noninvasive Treatment ◽  
Patients With Diabetes ◽  
Protective Sensation ◽  
Loss Of Protective Sensation ◽  
Drug Free ◽  
Sensation Loss

Forty-nine consecutive subjects with established diabetic peripheral neuropathy were treated with monochromatic near-infrared photo energy (MIRE) to determine if there was an improvement of sensation. Loss of protective sensation characterized by Semmes-Weinstein monofilament values of 4.56 and above was present in 100% of subjects (range, 4.56 to 6.45), and 42 subjects (86%) had Semmes-Weinstein values of 5.07 or higher. The ability to discriminate between hot and cold sensation was absent (54%) or impaired (46%) in both groups prior to the initiation of MIRE treatment. On the basis of Semmes-Weinstein monofilament values, 48 subjects (98%) exhibited improved sensation after 6 treatments, and all subjects had improved sensation after 12 treatments. Therefore, MIRE may be a safe, drug-free, noninvasive treatment for the consistent and predictable improvement of sensation in diabetic patients with peripheral neuropathy of the feet. (J Am Podiatr Med Assoc 92(3): 125-130, 2002)

Preferred Offloading Modalities for Management of Diabetic Foot Ulcers in Private Clinical Settings: A Survey of Australian Podiatrists

2021 ◽  
Author(s):  
Adriaan Erasmus ◽  
Michael Melek ◽  
Malia Ho
Keyword(s):  
Diabetic Foot ◽  
Online Survey ◽  
Management Strategies ◽  
Ease Of Use ◽  
Foot Ulcers ◽  
Diabetic Foot Ulcers ◽  
Therapeutic Footwear ◽  
Human Research Ethics ◽  
Protective Sensation ◽  
Loss Of Protective Sensation

Abstract Background Diabetic peripheral neuropathy is a common complication of diabetes mellitus. Neuropathy predisposes patients to diabetic foot ulcers (DFU) due to the loss of protective sensation and associated deformities. Management of foot ulcers are multifactorial, but pressure offloading can be considered as one of the most important aspects of management. According to IWGDF Guidelines, non-removable knee-high offloading devices are recommended as the 1st line of treatment for these ulcers. However, this is a very underutilised treatment modality. This study aimed to evaluate the practitioner preferred offloading modalities and reasons for their preference. Methods This project was approved by the university’s human research ethics committee. An online survey was distributed amongst Australian podiatrist via an industry related social media group. The survey collected simple demographical information, management strategies, preferred offloading modalities for the management of diabetic foot ulcers and reasons for their preferred method. Results Sixty-three podiatrists completed the survey with the majority practicing in private clinics. All practitioners treat diabetic foot ulcers regularly with most participants treating up to ten ulcer cases per week and 14% of participants treating more than 20 ulcers per week. Contrary to the IWGDF guidelines, standard therapeutic footwear was the most preferred method of management for the treatment of diabetic foot ulcers, with ease of use reported as the main reason for practitioners using this modality. Non-compliance to the use of non-removable knee-high offloading devices include perceived patient non-compliance and poor tolerance. Conclusion This study shows that practitioners’ offloading strategies do not adhere to the IWGDF guidelines. The reasons for not adhering to the guidelines seems to be a clinical practicality rather than evidence-based practice. Reasons for choosing a management strategy is multi-factorial (not just reducing plantar pressures). Further studies may be required to evaluate the effectiveness of therapeutic footwear in ulcer healing, taking into consideration other factors such as practitioner and patient preference, clinical practicality, and access to support. Based on the findings, this study provides suggestions on how to overcome the barriers that prevent podiatrist from adhering to the recommendations of the IWGDF when selecting offloading devices in general clinical practice.

Syringomyelia

2018 ◽  
pp. 203-208
Author(s):  
Ashwin Varma ◽  
Timothy Bednar ◽  
Gulshan Doulatram
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Substance P ◽  
Definitive Treatment ◽  
Central Pain ◽  
Vertebral Canal ◽  
Arnold Chiari Malformation ◽  
Post Traumatic ◽  
Pain Characteristics

This chapter discusses syringomyelia, which is dilation of the spinal canal. It can be either congenital or post-traumatic. It is associated with central pain characteristics of predominantly neuropathic pain. Headaches may be present in patients with syringomyelia associated with type 1 Arnold-Chiari malformation. The size of the syrinx does not correlate to the severity of pain. Damage to the deeper layers of the dorsal horn causes an imbalance between the inhibitory and excitatory stimuli with upregulation of substance P. Electromyography shows a mixture of shortened and prolonged action potentials in syringomyelia. Somatosensory-evoked potential may be useful in the electrodiagnosis of syringomyelia. MRI plays a key role in the diagnosis of syringomyelia. Medical treatment is multifaceted and may be unsuccessful in treating the neuropathic pain. Surgery is the definitive treatment, although symptoms of pain may persist after resection. Spinal cord stimulation may offer relief to some patients and can be considered, as long as the dimensions of the vertebral canal are not significantly compromised.

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