Pain in diabetic neuropathy case study: whole patient management

Abstract

Painful diabetic peripheral neuropathy (DPN) is described as a superficial burning pain associated with other positive and/or negative sensory systems affecting the feet and lower extremities. It is one of the most commonly encountered neuropathic pain syndromes in clinical practice. Presentation may be complicated by multiple symptoms, including allodynia, hyperalgesia, other less well characterized dysesthesias, and serious disruption of social functioning and mood. Peripheral nerve function may deteriorate, which can account for patient reports of diminution of pain after several years of follow-up. Although current understanding holds that the pathogenesis of DPN is multifactorial in nature, long-term studies have shown that rigorous glycemic control is the most relevant factor in clinical intervention and can delay the onset and slow the progression of neuropathy. In addition to glycemic control, other treatment approaches must be examined in order to restore quality of life for patients experiencing painful DPN. Differential diagnosis is required to isolate DPN from other unexplained chronic pain. Neurologic testing in painful DPN is an area of active research and is used to assess the neurologic pathways giving rise to the pain, the degree of neural damage and the degree of subclinical damage. Current treatment options for DPN include mainly antidepressants and anticonvulsants, with other agents such as tramadol, dextromethorphan and memantine being employed or studied. This review article includes a case study of a patient with painful DPN to demonstrate the current management strategies for this neuropathic pain syndrome.

Maladaptive Dendritic Spine Remodeling Contributes to Diabetic Neuropathic Pain

“…In particular, we have shown that maladaptive dendritic spine plasticity occurs on WDR neurons, which can contribute to adversely altered sensory processing associated with chronic pain (Tan et al, 2008(Tan et al, , 2009a. Neuropathic pain develops progressively over time in diabetic animal models and chronic diabetes in humans (Malcangio and Tomlinson, 1998;Marchettini et al, 2004;Singleton and Smith, 2007;Fischer et al, 2009). To determine whether diabetic neuropathic pain associated with changes in dendritic spine morphology, we first analyzed dendritic spines from spinal cord tissue collected 4 weeks after STZ or control injection ( Fig.…”

Altered antinociceptive efficacy of tramadol over time in rats with painful peripheral neuropathy

“…Neurological disorders, including chronic pain, evolve over time (Burchiel and Slavin, 2000;Chen et al, 2002;DeKosky and Marek, 2003;Gilman, 2006;Marchettini et al, 2004). Thus, a drug treatment that is efficacious in early stages may be less efficacious in later stages of the disease.…”

Ameliorative Potential of Spironolactone in Diabetes Induced Hyperalgesia in Mice

“…1,2) Similar to human diabetic pain, animal models such as streptozotocin (STZ)-induced diabetic mice also demonstrate thermal hyperalgesia and mechanical allodynia. 3,4) Spironolactone is an aldosterone receptor antagonist clinically employed as potassium-sparing diuretic.…”