New treatments for diabetic neuropathy: Symptomatic treatments

Abstract

Painful diabetic neuropathy is a common distressing and challenging condition. The mechanism or mechanisms involved in its pathogenesis continue to elude clinical scientists. As with other conditions of painful distal symmetrical neuropathic conditions, pain relief involves the use of a variety of analgesic and neuroleptic drugs, aimed at reducing either central responses to painful stimuli or at dampening spontaneous irritability of affected neurons. More recently, several therapies directed at putative pathologic mechanisms specific to painful diabetic neuropathy have evolved. These include vasodilators, protein kinase C beta inhibition, antioxidants, and novel aldose reductase inhibitors. Preliminary clinical studies of these therapies have at present involved small numbers of patients; however, the results have been encouraging. This article considers the clinical aspects of diagnosis and management of chronic painful diabetic neuropathy, focusing on existing and newer therapies.

C‐fos expression at the spinal dorsal horn of streptozotocin‐induced diabetic rats

“…The study of the mechanisms of painful diabetic neuropathy has been mainly focused at the peripheral nervous system, whereas the central effects of the disease need to be more deeply addressed [1,5]. Several studies suggested that the spinal dorsal horn, the first relay station of the nociceptive pathway, is affected by diabetes.…”

Practical Management of Patients With Painful Diabetic Neuropathy

“…Assessment should include monofilament, vibratory, and pinprick tests. 14 Reflexes and the strength and flexibility of the toes, foot, and ankle should also be assessed. 10,14 Feet should be observed and palpated for any signs of ulcer risk (eg, hammer toes, bunions, calluses, tender areas).…”

“…14 Reflexes and the strength and flexibility of the toes, foot, and ankle should also be assessed. 10,14 Feet should be observed and palpated for any signs of ulcer risk (eg, hammer toes, bunions, calluses, tender areas). Assessing for signs and symptoms of peripheral vascular disease, including pedal pulse quality, capillary refill, skin color and moisture, and ankle-brachial index, should be done.…”

“…Assessing for signs and symptoms of peripheral vascular disease, including pedal pulse quality, capillary refill, skin color and moisture, and ankle-brachial index, should be done. 14 In patients with PDN, decreased sensation is nearly always present although less prominent in persons with pure small fiber neuropathy. 14 Research has failed to demonstrate a definitive association between degree and chronicity of pain and nerve conduction loss.…”

“…14 In patients with PDN, decreased sensation is nearly always present although less prominent in persons with pure small fiber neuropathy. 14 Research has failed to demonstrate a definitive association between degree and chronicity of pain and nerve conduction loss. 2,15 However, it is generally believed that when chronic pain subsides or resolves, the resolution is a result of worsening pathology.…”