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Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy

Although a number of the diabetic neuropathies may result in painful symptomatology, this review focuses on the most common: chronic sensorimotor distal symmetrical polyneuropathy (DSPN). It is estimated that 15–20% of diabetic patients may have painful DSPN, but not all of these will require therap...

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Autores principales: Tesfaye, Solomon, Boulton, Andrew J.M., Dickenson, Anthony H.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: American Diabetes Association 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747929/
https://www.ncbi.nlm.nih.gov/pubmed/23970715
http://dx.doi.org/10.2337/dc12-1964
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author Tesfaye, Solomon
Boulton, Andrew J.M.
Dickenson, Anthony H.
author_facet Tesfaye, Solomon
Boulton, Andrew J.M.
Dickenson, Anthony H.
author_sort Tesfaye, Solomon
collection PubMed
description Although a number of the diabetic neuropathies may result in painful symptomatology, this review focuses on the most common: chronic sensorimotor distal symmetrical polyneuropathy (DSPN). It is estimated that 15–20% of diabetic patients may have painful DSPN, but not all of these will require therapy. In practice, the diagnosis of DSPN is a clinical one, whereas for longitudinal studies and clinical trials, quantitative sensory testing and electrophysiological assessment are usually necessary. A number of simple numeric rating scales are available to assess the frequency and severity of neuropathic pain. Although the exact pathophysiological processes that result in diabetic neuropathic pain remain enigmatic, both peripheral and central mechanisms have been implicated, and extend from altered channel function in peripheral nerve through enhanced spinal processing and changes in many higher centers. A number of pharmacological agents have proven efficacy in painful DSPN, but all are prone to side effects, and none impact the underlying pathophysiological abnormalities because they are only symptomatic therapy. The two first-line therapies approved by regulatory authorities for painful neuropathy are duloxetine and pregabalin. α-Lipoic acid, an antioxidant and pathogenic therapy, has evidence of efficacy but is not licensed in the U.S. and several European countries. All patients with DSPN are at increased risk of foot ulceration and require foot care, education, and if possible, regular podiatry assessment.
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spelling pubmed-37479292014-09-01 Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy Tesfaye, Solomon Boulton, Andrew J.M. Dickenson, Anthony H. Diabetes Care Bench to Clinic Symposia Although a number of the diabetic neuropathies may result in painful symptomatology, this review focuses on the most common: chronic sensorimotor distal symmetrical polyneuropathy (DSPN). It is estimated that 15–20% of diabetic patients may have painful DSPN, but not all of these will require therapy. In practice, the diagnosis of DSPN is a clinical one, whereas for longitudinal studies and clinical trials, quantitative sensory testing and electrophysiological assessment are usually necessary. A number of simple numeric rating scales are available to assess the frequency and severity of neuropathic pain. Although the exact pathophysiological processes that result in diabetic neuropathic pain remain enigmatic, both peripheral and central mechanisms have been implicated, and extend from altered channel function in peripheral nerve through enhanced spinal processing and changes in many higher centers. A number of pharmacological agents have proven efficacy in painful DSPN, but all are prone to side effects, and none impact the underlying pathophysiological abnormalities because they are only symptomatic therapy. The two first-line therapies approved by regulatory authorities for painful neuropathy are duloxetine and pregabalin. α-Lipoic acid, an antioxidant and pathogenic therapy, has evidence of efficacy but is not licensed in the U.S. and several European countries. All patients with DSPN are at increased risk of foot ulceration and require foot care, education, and if possible, regular podiatry assessment. American Diabetes Association 2013-09 2013-08-13 /pmc/articles/PMC3747929/ /pubmed/23970715 http://dx.doi.org/10.2337/dc12-1964 Text en © 2013 by the American Diabetes Association. Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.
spellingShingle Bench to Clinic Symposia
Tesfaye, Solomon
Boulton, Andrew J.M.
Dickenson, Anthony H.
Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
title Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
title_full Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
title_fullStr Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
title_full_unstemmed Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
title_short Mechanisms and Management of Diabetic Painful Distal Symmetrical Polyneuropathy
title_sort mechanisms and management of diabetic painful distal symmetrical polyneuropathy
topic Bench to Clinic Symposia
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3747929/
https://www.ncbi.nlm.nih.gov/pubmed/23970715
http://dx.doi.org/10.2337/dc12-1964
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