Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management

Diabetes/Metabolism Research and Reviews - Tập 27 Số 7 - Trang 629-638 - 2011
Solomon Tesfaye1, Loretta Vileikyte, Gerry Rayman, Søren H. Sindrup, Bruce A. Perkins, M Baconja, Aaron I. Vinik, Andrew J.M. Boulton
1Diabetes Research Unit, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK.

Tóm tắt

AbstractPainful diabetic peripheral neuropathy (DPN) is common, is associated with significant reduction in quality of life and poses major treatment challenges to the practising physician. Although poor glucose control and cardiovascular risk factors have been proven to contribute to the aetiology of DPN, risk factors specific for painful DPN remain unknown. A number of instruments have been tested to assess the character, intensity and impact of painful DPN on quality of life, activities of daily living and mood. Management of the patient with DPN must be tailored to individual requirements, taking into consideration the co‐morbidities and other factors. Pharmacological agents with proven efficacy for painful DPN include tricyclic anti‐depressants, the selective serotonin and noradrenaline re‐uptake inhibitors, anti‐convulsants, opiates, membrane stabilizers, the anti‐oxidant alpha‐lipoic acid and topical agents including capsaicin. Current first‐line therapies for painful DPN include tricyclic anti‐depressants, the serotonin and noradrenaline re‐uptake inhibitor duloxetine and the anti‐convulsants pregabalin and gabapentin. When prescribing any of these agents, other co‐morbidities and costs must be taken into account. Second‐line approaches include the use of opiates such as synthetic opioid tramadol, morphine and oxycodone‐controlled release. There is a limited literature with regard to combination treatment. In extreme cases of painful DPN unresponsive to pharmacotherapy, occasional use of electrical spinal cord stimulation might be indicated. There are a number of unmet needs in the therapeutic management of painful DPN. These include the need for randomized controlled trials with active comparators and data on the long‐term efficacy of agents used, as most trials have lasted for less than 6 months. Finally, there is a need for appropriately designed studies to investigate non‐pharmacological approaches. Copyright © 2011 John Wiley & Sons, Ltd.

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Tài liệu tham khảo

10.2337/dc10-1303

10.2337/diacare.27.6.1458

10.2337/dc08-0107

10.2337/diacare.25.11.2010

10.1093/med/9780199551064.001.0001

10.1212/01.wnl.0000282763.29778.59

10.1097/01.ajp.0000210910.49923.09

10.1002/dmrr.360

10.1016/j.jpain.2010.01.075

10.2337/diacare.28.10.2378

10.1007/s00125-009-1363-2

10.1016/j.jpainsymman.2005.04.009

Sankar A, 2010, Significant impact of mood disturbances of pain perception in painful DPN:time to re‐evaluate current practice?, Diabetologia, 53, S446

10.1007/BF00418349

10.1210/jc.2010-0892

10.1111/j.1464-5491.2004.01271.x

10.1007/s00125-005-1721-7

10.1046/j.1464-5491.2002.00801.x

Eaton SE, 2003, Differences insural nerve haemodynamics in painful and painless neuropathy, Diabetologia, 934

10.2337/dc06-2154

10.2337/diacare.29.04.06.dc05-2180

10.2337/dc10-1550

10.2337/dc09-2314

10.2337/diacare.28.4.956

10.1111/j.1468-1331.2010.02969.x

10.1016/j.pain.2003.12.024

10.1016/j.jpainsymman.2004.06.018

10.1097/00002508-200309000-00005

10.1016/S0304-3959(00)00482-6

10.1016/0304-3959(87)91074-8

10.2337/diacare.26.9.2549

10.1089/dia.2005.7.497

10.1016/j.jpainsymman.2008.01.012

10.1111/j.1600-0447.1983.tb09716.x

10.1016/j.pain.2010.06.019

10.1111/j.1742-7843.2005.pto_96696601.x

10.1016/j.clpt.2003.09.019

Kajdasz DK, 2007, Duloxetine for the management of diabetic peripheral neuropathic pain: evidence‐based findings from post hoc analysis of three multicentre, randomised, double‐blind, placebo‐controlled, parallel‐group studies, Clin Ther, 29, 536

10.1001/jama.280.21.1831

10.2337/dc07-2105

10.1016/j.clinthera.2005.09.011

10.1016/0304-3959(87)91061-X

10.2165/00003495-199856040-00016

10.1212/WNL.50.6.1842

10.1212/01.WNL.0000057720.36503.2C

10.1111/j.1464-5491.2009.02806.x

10.1016/S0140-6736(09)61081-3

10.1056/NEJMoa042580

10.1007/BF00196108

10.1111/j.1464-5491.2004.01109.x

10.1136/bmj.b3002

10.1155/2007/730785

10.1111/j.1468-1331.2010.02999.x

NICE Clinical Guideline 96: Neuropathic Pain. The pharmacological management of neuropathic pain in adults in non‐specialist settings March 2010. Available at:http://guidance.nice.org.uk/CG96[Accessed 26 July 2011].

10.1016/S0168-8227(97)00123-X

10.2337/diacare.27.1.168

10.2337/diacare.27.4.921

10.1111/j.1464-5491.2004.01243.x

10.1007/s00125-005-1734-2

10.1007/s00125-005-1728-0

10.1016/S0140-6736(96)02467-1

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Diabetes/Metabolism Research and Reviews

Tập 27 Số 7

629-638

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