Pain Management in People with Diabetes-Related Chronic Limb-Threatening Ischemia

Abstract

Management of neuropathic pain in people with diabetes has been widely investigated. However, little attention was paid to address ischemic-related pain in patients with diabetes mellitus who suffered from chronic limb-threatening ischemia (CLTI), the end stage of lower extremity arterial disease (LEAD). Pain management has a tremendous influence on patients’ quality of life and prognosis. Poor management of this type of pain owing to the lack of full understanding undermines patients’ physical and mental quality of life, which often results in a grim prognosis, such as depression, myocardial infarction, lower limb amputation, and even mortality. In the present article, we review the current strategy in the pain management of diabetes-related CLTI. The endovascular therapy, pharmacological therapies, and other optional methods could be selected following comprehensive assessments to mitigate ischemic-related pain, in line with our current clinical practice. It is very important for clinicians and patients to strengthen the understanding and build intervention strategy in ischemic pain management and possible adverse consequence.

Observation of the immediate effect of ultrasound-guided acupuncture at Zusanli (ST36) point on Blood flow volume in lower limb arteries: a randomized controlled trial study protocol

“…Research conducted across multiple centers in China revealed a 19.5% occurrence of LEAD in diabetic patients aged over 50 [25] , in contrast to a single-center study which indicated a higher rate of 35.4% in diabetic patients over 60 years with LEAD [26] . Presently, LEAD's clinical treatments encompass endovascular therapy, pharmacotherapy, rehabilitation, surgical procedures, and cellular therapy [27] . While these therapies have demonstrated e cacy in enhancing LEAD patients' symptoms and outlook, the expense of their treatment remains irrefutable.…”

The role of allogeneic platelet-rich plasma in patients with diabetic foot ulcer: Current perspectives and future challenges

“…It has been reported that DFU may have a worse prognosis than some forms of cancer ( Armstrong et al, 2020 ). Patients with DFU always have a poor systemic condition, poor skin wound-healing performance and ulcer recurrence ( Jiang et al, 2021 ). Hence, exploring a new, prompt, effective and safe approach for the promotion of DFU closure is key to reduce morbidity and mortality.…”

Custom-Molded Offloading Footwear Effectively Prevents Recurrence and Amputation, and Lowers Mortality Rates in High-Risk Diabetic Foot Patients: A Multicenter, Prospective Observational Study

“…Health facilities and clinicians should also increase awareness of different approaches for treatment and disease prevention, while patients and medical staff should undergo health education to equip them with information regarding the positive effects of offloading therapy. 31 We hypothesize that increased health education for patients and medical staff will improve the level of foot self-care knowledge and patient behavior towards the therapy. Furthermore, medical personnel should undergo regular training on prevention and adjuvant treatment of diabetic foot using offloading device to improve their effectiveness in providing care for patients with high-risk foot.…”