Calcitonin nasal spray for painful diabetic neuropathy

Diabetic neuropathy is a most common and troublesome complication of diabetes mellitus, leading to the greatest morbidity and mortality and resulting in a huge economic burden for diabetes care [1,2]. It is the most common form of neuropathy in the developed countries of the world, accounts for more admission to hospital than all the other diabetic complications combined and is responsible for 50±75 % of non-traumatic amputations [2,3]. Diabetic neuropathy is a set of clinical syndromes that affect distinct regions of the nervous system, singly or combined. It can be silent and go undetected, while exercising its ravages, or be present with clinical symptoms and signs that although non-specific and insidious with slow progression also mimic those seen in many other diseases. It is, therefore, diagnosed by exclusion.Diabetic neuropathy is a heterogeneous disorder that encompasses a wide range of abnormalities affecting proximal and distal peripheral sensory and motor nerves as well as the autonomic nervous systems. For these reasons, it has been difficult to obtain precise estimates of the true prevalence and reports vary from 10 to 90 % in diabetic patients, depending on the criteria and methods used to define neuropathy [1±5]. From patients attending a diabetes clinic 25 % reported symptoms; 50 % were found to have neuropathy after a simple clinical test such as the ankle jerk or vibration perception test; almost 90 % tested positive to sophisticated tests of autonomic function or peripheral sensation [6]. Neurologic complications occur equally in Type I (insulin-dependent) and Type II (non-insulin-dependent) diabetes mellitus and additionally in various forms of acquired diabetes [5]. The major morbidity associated with somatic neuropathy is foot ulceration, the precursor of gangrene and limb loss. Neuropathy increases the risk of amputation 1.7-fold; 12-fold, if there is deformity (itself a consequence of neuropathy), and 36-fold, if there is a history of previous ulceration [7]. There are 65,000 amputations in the United States each year, one every 10 min, and neuropathy is considered to be the major contributor in 87 % of cases. It is also the most life-spoiling of the diabetic complications and has tremendous ramifications for the quality of life of the person with diabetes. Once autonomic neuropathy sets in, life can become quite dismal and the mortality rate approximates 25±50 % within 5±10 years [8,9]. In this review we present and discuss the most recent approaches to the diagnosis and treatment of diabetic neuropathy and the prospects on the horizon. ClassificationDiabetic neuropathy is not a single entity but a number of different syndromes, ranging from subclinical to clinical manifestations depending on the classes of nerve fibres involved. According to the San Antonio Convention [10], the main groups of neurologic disturbance in diabetes mellitus include: (1) subclinical neuropathy, determined by abnormalities in electrodiagnostic and quantitative sensory testing, (2) dif- Diabetologia (2000) 43:...

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“…About 39 % of the patients had near-complete relief of symptoms. The improvement was seen after only 2 weeks of treatment [97].…”

Section: Transcutaneous Nerve Stimulation (Electrotherapy)mentioning

confidence: 90%

Diabetic neuropathies

et al. 2000

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“…Direct epidural or subarachnoidal injection of CT has also shown án analgesic effect [82,83]. Besides pain management in osteoporosis [77,[84][85][86] CT has shown analgesic action in painful conditions such as phantom limb pain [87,88], diabetic neuropathy [89], complex regional pain syndrome [90], adhesive capsulitis [91,92], rheumatoid arthritis [93], vertebral crush fractures [94,95], spondylitis, tumor metastasis [96], cancer pain [97], migraine [98,99], Paget's disease of bone [100]) as well as post-operative pain [101].…”

Section: Does Calcitonin Improve Bone Quality?mentioning

confidence: 97%

Oral salmon calcitonin – pharmacology in osteoporosis

Henriksen¹,

Bay‐Jensen²,

Christiansen³

et al. 2010

Expert Opinion on Biological Therapy

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“…In a small study, calcitonin 100 IU daily relieved pain in 39% patients by two weeks. 50 Transcutaneous nerve stimulation, magnetic field therapy, infrared light therapy, and spinal cord stimulation has been tried in small number of patients with painful DN.…”

Section: Ad Painmentioning

confidence: 99%

Diabetic neuropathy

Bansal

Kalita

Misra

2006

Postgraduate Medical Journal

278

195

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Diabetic neuropathy (DN) refers to symptoms and signs of neuropathy in a patient with diabetes in whom other causes of neuropathy have been excluded. Distal symmetrical neuropathy is the commonest accounting for 75% DN. Asymmetrical neuropathies may involve cranial nerves, thoracic or limb nerves; are of acute onset resulting from ischaemic infarction of vasa nervosa. Asymmetric neuropathies in diabetic patients should be investigated for entrapment neuropathy. Diabetic amyotrophy, initially considered to result from metabolic changes, and later ischaemia, is now attributed to immunological changes. For diagnosis of DN, symptoms, signs, quantitative sensory testing, nerve conduction study, and autonomic testing are used; and two of these five are recommended for clinical diagnosis. Management of DN includes control of hyperglycaemia, other cardiovascular risk factors; alpha lipoic acid and L carnitine. For neuropathic pain, analgesics, non-steroidal anti-inflammatory drugs, antidepressants, and anticonvulsants are recommended. The treatment of autonomic neuropathy is symptomatic.

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Calcitonin nasal spray for painful diabetic neuropathy

Cited by 24 publications

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Diabetic neuropathies

Diabetic neuropathies

Oral salmon calcitonin – pharmacology in osteoporosis

Diabetic neuropathy

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