In a randomized double-blind, cross-over study the effect of intravenous lidocaine (5 mg/kg body weight) on the symptoms and signs of painful diabetic neuropathy of more than 6 months duration has been evaluated. Using a clinical symptom scale, there was significant beneficial effect 1 and 8 days after lidocaine infusion compared to after saline infusion (P less than 0.05 and P less than 0.02, respectively). The duration of the individual effect ranged from 3 to 21 days. Lidocaine infusion had no effect on the objective measurements of neuropathy. Intravenous lidocaine infusion seems to be a new alternative treatment of chronic painful diabetic neuropathy.
In a double-blind controlled design, 7 patients with painful diabetic neuropathy received lidocaine 5 mg/kg or saline intravenously over a period of 30 min. Thermal sensibility quantified by thermotest was not affected by lidocaine. In 3 of the patients nociceptive flexion reflex thresholds could be determined. The threshold was increased by lidocaine and returned to pre-infusion level within 10 days. Lidocaine also increased the threshold in 4 healthy subjects, but did not affect the Hoffmann reflex. These results suggest that lidocaine exerts its pain-relieving effect on the spinal level in diabetic neuropathy.
173as distance) is decisive despite the regulations, which are couched as a series of alternatives.2 Decisions are made by lay officers interpreting a medical report which pays insufficient attention to assessment of mobility.3 This study therefore measured not only aspects of the mobility of holders of the allowance but also the collective opinions ofa group ofassessors. The results should interest organisations representing disabled people.4Most subjects walked more than the 100 m quoted in cases turned down on appeal. They were, however, studied under less stressful and more representative conditions than when being examined for the mobility allowance. The wide scatter ofresults confirms the variability ofassessments and the need to rationalise the system for making the award. It is impossible to set a limiting value for any parameter but the likelihood of an applicant being successful increases as distance, speed, and time ofwalking decrease. I have therefore suggested three categories bounded by distances (120 m, 240 m, and 360 m) and speeds (20 m/min, 34 m/min, and 43 m/min) which might be the basis of a points system. Other parameters of mobility-for example, energy expenditure-would also have to be considered and weighted.The Department of Health and Social Security should commission an independent evaluation ofmethods ofassessing mobility, which would make examinations for the mobility allowance more objective and thereby reduce criticism of this allowance and examining doctors.
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