Professional Documents
Culture Documents
Hui-Chuan Hsu1
Chih-Chung Liu2
Background and purpose: The definition, clinical presentation, and treatment of diabetic
neuropathic pain were reviewed. Results: The estimated prevalence of diabetic neuropathic pain
is up to 22% based on a population of 270 million in the US. Diabetic neuropathy is one of the most
common complications of type 2 diabetes mellitus (T2DM). Diabetic neuropathic pain is a
sensorimotor neuropathy, or a distal symmetrical polyneuropathy, which is the most common type
of excruciating, refractory pain in T2DM patients. Positive symptoms include pain and
paresthesia. Patients complain about burning, tingling, aching, cold sensation, lancinating pain,
numbness, or pain from normal touch. Painful symptoms occur in a part (11%-32%) of neuropathic
patients with diabetes and do not correlate with diminished nerve conduction velocity. Thus
electrophysiological testing is rarely needed according to the recommendations of the American
Diabetes Association in 2010. The multifactorial pathogenesis of diabetic neuropathy suggested by
recent research includes the polyol pathway, oxidative stress, advanced glycation end products,
and protein kinase C. Medications for relief of diabetic neuropathic pain are recommended to
improve the quality of life. For neuropathic pain control, the efficacy of tricyclic antidepressants,
gabapentin, pregabalin, opioids, and tramadol is documented. Selective serotonin noradrenaline
reuptake inhibitors, topical lidocaine, and transcutaneous electrical stimulation are therapies with
some evidence of efficacy. Conclusions: Treatment is a great challenge, and has to be
individualized to each patient, by taking into account side effects, pain type, comorbidities, and
drug interactions. As poor glycemic control may worsen diabetic neuropathic pain, it is important
to achieve a glucose target as rapidly as possible. ( FJJM 2010; 8 (1) : 39-47 )
Key words: diabetic neuropathic pain, distal symmetric polyneuropathy, diabetic
peripheral neuropathic pain, type 2 diabetes mellitus
INTRODUCTION
Diabetic neuropathy is the most common
complication of type 2 diabetes mellitus (T2DM).
Diabetic neuropathic pain is a sensorimotor
neuropathy or a distal symmetrical polyneuropathy
(DPN), whichis the most common type of neuropathy,
Division of Endocrinology and Metabolism, Department of Internal Medicine, Sijhih Cathay General Hospital1
Anesthesiology, Sijhih Cathay General Hospital2 Department of Medicine, Fu-Jen Catholic University3
Submitted March, 8, 2010; final version accepted March, 31, 2010.
*Correspondence author: hlsun@cgh.org.tw
8 1 2010
Department of
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Shin-Yi Tsao
Hui-Chuan Hsu
Chih-Chung Liu
Hsiao-Lun Sun
40
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[28]
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Shin-Yi Tsao
Hui-Chuan Hsu
Chih-Chung Liu
Hsiao-Lun Sun
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Substance P inhibitor
Topical capsaicin (0.075%) applied sparingly
3 or 4 times per day to the affected area was found
to relieve neuropathic pain by depleting substance
Pfromnerveterminals[47].IntheADArecommendations
of 2010, the dose of capsaicin was 0.025%~0.075%
in cream applied tid to qid.
-Lipoic acid
-Lipoic acid is pathogenetically oriented
treatment with 600mg by intravenous infusion for
at least 3 weeks. -Lipoic acid reduces oxygen free
radicals and improves oxidative stress. A metaanalysis including 1258 patients from four prospective
trials showed that treatment with -lipoic acid
(600 mg/day intravenously) for 3 weeks was
associated with significant improvement in diabetic
neuropathic pain[48]. Oral -lipoic acid takes about
5 weeks to improve diabetic neuropathic pain[49].
Nonpharmacological treatments
Physical therapy is an alternative therapy for
patients who suffer from side effects or, and it may
co-exist with medicine to relieve diabetic neuropathic
pain. There are many alternative therapies such as
balneotherapy, relaxation therapy[40], acupuncture
[50]
, near-infrared phototherapy[51], low-intensity
laser therapy[52], magnetic field therapies[16],
transcutaneous electrical nerve stimulation[53],
frequency-modulated electromagnetic neural
stimulation therapy[54,55], high-frequency external
muscle stimulation[56], and even psychological
support. However, the efficacy of these alternative
treatments is inconclusive and depends on the
individual.
CONCLUSIONS
Painful diabetic neuropathy is a common cause
of neuropathic pain and produces significant
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Shin-Yi Tsao
Hui-Chuan Hsu
Chih-Chung Liu
Hsiao-Lun Sun
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Hui-Chuan Hsu
Chih-Chung Liu
Hsiao-Lun Sun
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1 1
2,3,*
( 20108 (1)39-47)
1 2
2010 03 08 2010 03 31
*: : hlsun@cgh.org.tw
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