scholarly journals Diabetic Peripheral Neuropathy: Epidemiology, Physiopathology, Diagnosis and Treatment

2019 ◽  
Vol 7 (1) ◽  
pp. 35-48
Author(s):  
Nazma Akter
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Clinical Evidence ◽  
Current Treatment ◽  
Diabetic Patients ◽  
First Line ◽  
Diabetic Neuropathic Pain ◽  
Current Treatment Regimen ◽  
Limb Proprioception

Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and type 2 diabetes. It affects over 90% of the diabetic patients. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. 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. DPN is often misdiagnosed and inadequately treated. Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvant in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. The purpose of this review is to examine proposed mechanisms of DPN, summarize current treatment regimen. A better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies. Delta Med Col J. Jan 2019 7(1): 35-48

Effect of Acupuncture on Diabetic Peripheral Neuropathy: An Uncontrolled Preliminary Study from Korea

2014 ◽  
Vol 32 (4) ◽  
pp. 350-352 ◽  
Author(s):  
Eonju Jeon ◽  
Hyojung Kwon ◽  
Imhee Shin ◽  
Seokbong Kang ◽  
Hosang Shon
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Complete Relief ◽  
Diabetic Neuropathic Pain ◽  
Full Study ◽  
Michigan Neuropathy Screening Instrument ◽  
Preliminary Study

Background Diabetic neuropathic pain can severely influence quality of life, and patients may be dissatisfied with treatment. Objective To carry out an observational study of the effects of acupuncture for the treatment of diabetic neuropathic pain, in preparation for a full study. Methods Nine patients with diabetic neuropathic pain were recruited from a Korean diabetic clinic and given 12 sessions of acupuncture over 4 weeks. Their symptoms were evaluated using the Total Symptom Score (TSS) and Michigan Neuropathy Screening Instrument (MNSI) at baseline and 4 weeks after the last treatment. Results Mean TSS scores reduced from 7.99 (SD 3.55) at baseline to 4.95 (SD 4.41), at the 8-week follow-up—a statistically non-significant change (p=0.057). The MNSI scores improved from 6.33 (SD 1.31) before treatment to 4.33 (SD 3.00) after acupuncture treatment—a significant improvement (p=0.010). One participant experienced an exacerbation of diabetic neuropathy symptoms, but two patients gained complete relief of their diabetic peripheral neuropathy (DPN) symptoms. Conclusions The results of this study justify further investigations into the effects of acupuncture on DPN.

scholarly journals A Review on Diabetic Peripheral Neuropathy

2021 ◽  
Vol 11 (2-S) ◽  
pp. 121-125
Author(s):  
Jasaswi Ray ◽  
Chinmaya Keshari Sahoo ◽  
Rajashree Mohanty ◽  
Rakesh Sahoo ◽  
Rajashree Dalai
Keyword(s):  
Peripheral Neuropathy ◽  
Diabetic Peripheral Neuropathy ◽  
Diabetic Patients ◽  
Pharmacological Management ◽  
Noradrenaline Reuptake ◽  
Limb Proprioception

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 lidocaine. The objectives of this paper are to review current guidelines for the pharmacological management of DPN. Keywords: DPN, hyperglycemia, depression, lidocaine

scholarly journals Acupuncture in diabetic peripheral neuropathy—protocol for the randomized, multicenter ACUDPN trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
J. Dietzel ◽  
S. Hörder ◽  
I. V. Habermann ◽  
G. Meyer-Hamme ◽  
K. Hahn ◽  
...  
Keyword(s):  
Neuropathic Pain ◽  
Peripheral Neuropathy ◽  
Nerve Conduction ◽  
Diabetic Peripheral Neuropathy ◽  
Clinical Symptoms ◽  
Multicenter Trial ◽  
Routine Care ◽  
Open Label ◽  
Diabetes Type Ii ◽  
Parallel Group

Abstract Background Acupuncture is used to treat patients with diabetic peripheral neuropathy; however, the evidence is unclear. We present the design and methodology of the ACUDPN (ACUpuncture in Diabetic Peripheral Neuropathy) trial, which investigates the effectiveness of acupuncture for the treatment of diabetic peripheral neuropathy (DPN) symptoms. The aim of this study is to investigate whether acupuncture is effective for the treatment of DPN symptoms. Methods This study is a two-armed, randomized, controlled, parallel group, open-label, confirmatory, multicenter trial (8-week intervention period plus 16 weeks of follow-up). Physicians in outpatient units in Germany who specialize in acupuncture treatment will treat 110 diabetes type II patients with clinical symptoms of peripheral neuropathy in the feet and legs with signs of neuropathy according to nerve conduction testing. The patients will be randomized in a 1:1 ratio to one of the following two groups: (a) semi-standardized acupuncture plus routine care or (b) routine care alone. Acupuncture will consist of 12 treatments per patient over 8 weeks. The primary outcome will be the overall DPN-related complaints in the extremities after 8 weeks as measured by the Visual Analog Scale (VAS). Further outcome measures will include DPN-related pain, the Neuropathic Pain Symptom Inventory (NPSI), Diabetic Peripheral Neuropathic Pain Impact (DPNPI) scores, and nerve conduction parameters of the sural nerve at weeks 8, 16, and 24. Discussion The results of this trial will be available in 2021 and will help clarify whether acupuncture can be considered effective for the treatment of DPN with regard to the subdimensions of the neuropathic clinical picture. Trial registration ClinicalTrials.gov NCT03755960. Registered on 11 August 2018.

Pharmacological Treatment of Diabetic Peripheral Neuropathy: An Update

2021 ◽  
Vol 20 ◽  
Author(s):  
Mohamed Rafiullah ◽  
Khalid Siddiqui
Keyword(s):  
Peripheral Neuropathy ◽  
Pharmacological Treatment ◽  
Diabetic Peripheral Neuropathy ◽  
Pharmacological Therapy ◽  
Line Treatment ◽  
Pharmacological Treatments ◽  
First Line ◽  
Short Term ◽  
Disease Modifying Agents ◽  
Third Line

: Neuropathy is the most common complication of diabetes. 50% of adults with diabetes will develop neuropathy in their lifetime. Diabetic peripheral neuropathy (DPN) is the major form of neuropathy found in 75% of diabetic neuropathy incidences. Pharmacological treatments are recommended for pain management in DPN. Anticonvulsants like pregabalin and gabapentin are the preferred first-line treatment, followed by amitriptyline, duloxetine, and venlafaxine. Topical agents like capsaicin and isosorbide dinitrate are also useful in treating the DPN and may be considered for the second or third-line treatment. Opioids and related drugs are suggested for short-term use during the acute exacerbation of pain. Combination therapy may be beneficial in patients who do not respond to monotherapy. However, currently, there is no compelling evidence to suggest any specific combination of agents. Disease-modifying agents such as alpha-lipoic acid and epalrestat appear to improve the disease state but are not recommended by any guideline. This review discusses the available pharmacological therapy for treating DPN. Also, we highlight the recommendations from different guidelines about the pharmacological treatment of DPN.

scholarly journals EGCG Prevents the Loss of Pontine Noradrenergic Neurons Induced by Diabetes: A Role in Diabetic Neuropathic Pain

2012 ◽  
Vol 18 (S5) ◽  
pp. 5-6 ◽  
Author(s):  
Carla Morgado ◽  
João Silva ◽  
André Miranda ◽  
Patrícia Pereira-Terra ◽  
Diogo Raposo ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Neuropathic Pain ◽  
Diabetic Rats ◽  
Pain Modulation ◽  
Diabetic Patients ◽  
Spontaneous Pain ◽  
Noradrenergic Neurons ◽  
Diabetic Neuropathic Pain ◽  
Descending Pain Modulation ◽  
Pain Responses

Diabetes is a major health problem with an alarming increasing prevalence, and is the most frequent cause of neuropathy worldwide. Neuropathy affects 50–60% of diabetic patients, being a major life-quality impairment for a quarter of these patients. Diabetic neuropathic pain (DNP) is characterized by spontaneous pain, mechanical hyperalgesia and tactile allodynia and is accompanied by functional and neurochemical changes at the peripheral nerves, spinal cord and supraspinal pain control areas. Regarding the effects of diabetic neuropathy in the central somatossensory system, it was shown that streptozotocin (STZ)-diabetic rats present spontaneous hyperactivity and hyperexcitability of spinal nociceptive neurons, which may be subserving the exacerbated pain responses. The spinal functional changes and pain may be due to increased peripheral input(2), changes in spinal nociceptive modulatory mechanisms and altered supraspinal descending pain modulation. Noradrenergic descending pain modulation seems to be impaired since STZ-diabetic rats present decreased numbers of noradrenergic neurons at the A5 and A7 pontine cell groups, along with lower levels of noradrenaline at the spinal cord and higher behavioral responses to pain. This is consistent with the strong noradrenergic projection from A5 and A7 neurons to the spinal dorsal horn and the modulation of nociceptive transmission by local release of noradrenaline. The mechanisms underlying the decrease in noradrenergic neurons in the brainstem during diabetes remain unclear. Our recent findings that diabetes induces oxidative stress damage in neurons from those areas, lead us to hypothesize that it may contribute to their loss. Thereafter, with the present study we aimed to evaluate the effects of Epigallocathechin Gallate (EGCG), a potent antioxidant present in green tea, on spinal noradrenaline levels, on A5 and A7 noradrenergic neurons and on behavioral pain responses of STZ-diabetic rats.

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