Management of Diabetic Peripheral Neuropathic Pain
Management of Diabetic Peripheral Neuropathic Pain
US Endocrine Review 2005 - September 2005
Published: October 2008
Published: October 2008
Diabetes remains the most common cause of neuropathy in the US, and neuropathy is the most common complication and greatest source of morbidity and mortality in diabetic patients. Additionally, emerging studies suggest that impaired glucose tolerance may lead to polyneuropathy, particularly painful small-fiber neuropathy. It is estimated from epidemiological studies that the prevalence of neuropathy in diabetic patients is approximately 30% in hospitalized patients and 20% in community-dwelling diabetic patients.
However, the epidemiology of the diabetic neuropathies has been difficult to establish with precision because the criteria for diagnoses vary, epidemiologic studies are limited to patients receiving medical care, and diabetes remains undiagnosed in a large population of subjects. Therefore, diabetic neuropathy may be implicated in 50% to 75% of non-traumatic amputations of lower limbs.
Neuropathic pain is defined by the International Association for the Study of Pain as “pain initiated or caused by a primary lesion or dysfunction of the nervous system”.1 Neuropathic pain can be thought of as pain that arises from abnormal nervous system physiology with diverse clinical manifestations and can affect virtually every tissue of the body.Members of an International Consensus agreed on a simple definition of diabetic neuropathy as the presence of symptoms and/or signs of peripheral nerve dysfunction in people with diabetes after the exclusion of other causes.
Approximately 10% of peripheral neuropathy in diabetes appears to be of non-diabetic etiology. For this reason, it is very important to conduct a careful clinical examination and always consider that absence of symptoms must never be equated with absence of neuropathy.
Several randomized controlled clinical trials completed over recent years have demonstrated the effect of improved glycemic control on microvascular and neurological complications of diabetes. Among the most representative in type 1 diabetes is the Diabetes Control and Complications Trial (DCCT) trial and the most representative in type 2 diabetes is the UK Prospective Diabetes Study (UKPDS).The DCCT shows us that the intensive treatment group achieved a median glycosylated hemoglobin (Hb) A1C of 7.2% during a mean follow-up of 6.5 years and a dramatic 64% reduction for confirmed clinical neuropathy. The UKPDS failed to support a similar correlation between incidence of neuropathy and glycemic control in type 2 diabetes patients, but the progression of diabetic neuropathy is dependent on glycemic control.
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- Duby J J, Campbell R K, Setter S M,White J R, Rasmussen K A,“Diabetic neuropathy: An intensive review”, Am. J. Health- Syst. Pharm. (2004);61: pp. 160–173.
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- Medina-Santillán R, Morales-Franco G, Espinoza-Raya J, Granados-Soto V, Reyes-García G, “Treatment of Diabetic Neuropathic Pain with Gabapentin Alone or Combined with Vitamin B Complex. Preliminary Results”, Proc.West Pharmacol. Soc. (2004);47: pp. 109–112.
