Acute Painful Peripheral Diabetic Neuropathy: A Life Limiting Morbidity and it’s Treatment

Diabetes is a pandemic disease and the painful neuropathy is one of the most debilitating complications. It is characterized by constant, sudden onset burning pain along with paresthesia and intermittent sharp, shooting pain, usually involving the extremities. It handicaps the daily activities of the patient, interferes with sleep and also affects the mood. Case: We report the case of a 30-year-old male, with Type 1 DM who presented with complaints of painful neuropathy in the lower extremities. Conclusion: Painful neuropathy is an increasing threat and is often not detected or misdiagnosed due to inconsistent definitions and lack of diagnostic criteria. The knowledge of this condition in very important not only to diagnose it but also to appropriately manage a case, from the widely available pharmacological options.

Assessment Of Therapeutic Efficacy And Safety Of Delphinium Denudatum Wall (jadwar) And Local Application Of Iris Florentina (roghan Sosan) In Painful Diabetic Neuropathy: A Randomised Single Blind Standard Controlled Study

The current study was conducted to assess the efficacy and safety of Delphinium denudatum(Jadwar)androghansosan in patients with painful diabetic neuropathy. A randomised single-blind standard controlled trial was carried out on 30 diagnosed patients of painful diabetic neuropathy at National Institute of Unani Medicine Bangalore-India. After obtaining ethical clearance, 30 eligible patients were randomly allocated into test and control groups, comprising 15 patients in each group. Patients of test group were given Delphinium denudatum wall (Jadwar) 500mg in tablet form twice daily and local application of;Iris florentina (roghansosan) on both feet twice daily. The patients of control group were given Strychnosnuxvomica (Azaraqi) 500 mg in tablet form twice daily for a period of 45 days. The subjective parameter- Visual analogue scale (VAS) was statistically analysed by applying Student’s test, two tailed dependent for intragroup comparison, two tailed independent for intergroup comparison and Levene’s test for the homogeneity of variance. VAS showed strongly significant difference (p<0.001) in intragroup comparison in both groups. The study revealed that test drugs appeared to be efficacious in the management of painful diabetic neuropathy and exhibited significant effects in improvement of neuronal function. No adverse effects or toxicity has been reported during or after the trial.

Efficacy and safety of pregabalin versus amitriptyline in patients with painful diabetic neuropathy

Background: Painful diabetic neuropathy is a common complication of long standing diabetes mellitus. Amitriptyline is commonly used to treat painful diabetic neuropathy. Pregabalin has been shown to be effective in the treatment of painful diabetic neuropathy with lesser adverse effects. Sustained release (SR) of pregabalin has the advantage of once daily dosing and a better patient compliance. Hence, this study was planned to compare the efficacy and safety of pregabalin-SR with amitriptyline in painful diabetic neuropathy.Methods: It is a prospective, open labelled, randomized controlled study. A total of 80 patients diagnosed with painful diabetic neuropathy based on Diabetic neuropathy symptom score and Michigan neuropathy screening instrument, were randomized into two groups to receive amitriptyline and pregabalin SR. Amitriptyline was started at 25mg OD and pregabalin SR 75mg OD for 6 weeks with optional dose titration. Patients were assessed for pain relief by using visual analogue scale and an overall improvement in their general condition by patient’s global impression of change scale. Adverse drug reactions were recorded on each follow up.Results: All patients had significant improvement in pain relief in both the treatment groups. The median VAS (visual analogue scale) score was slightly higher in pregabalin SR group (25 vs 22) however it was not statistically significant. Intergroup comparison did not show any significant differences between the treatment groups. Good and moderate pain relief were noted in 37(92.5%) and 3(7.5%) patients on amitriptyline and 36 (90%) and 4 (10%) patients on pregabalin SR respectively. The common adverse effects reported in amitriptyline group were drowsiness (27.5%) and dry mouth (17.5%) and in pregabalin-SR group were drowsiness (15%) and dizziness (5%). No serious adverse event was reported in either of the groups.Conclusions: In patients with painful diabetic neuropathy both amitriptyline and pregabalin-SR are equally effective in alleviating pain and improving the patient’s general condition, but pregabalin-SR has the advantage of fewer adverse effects and convenient dosage timing.

An observational study of the combination therapy of Gabapentin and Cobamamide in treatment of painful diabetic neuropathy / 中国糖尿病杂志

Objective To investigate the effect of combination therapy of Gabapentin and Cobamamide in treatment of painful diabetic neuropathy (PDN).Methods A total of 96 patients with type 2 diabetes (T2DM) and PDN were enrolled in this study and randomly divided into control group (Con,n=32),Cobamamide group,(n=32),and Gabapentin+Cobamamide group,(n=32).FPG and HbA1c were actively controlled in each group.Con group was treated with vitamin B1.Clinical and biochemical data of all the subjects were collected.The degree of pain was assessed by visual analogue scale (VAS).The changes of median nerve,peroneal nerve motor nerve conduction velocity (MNCV),and sensory nerve conduction velocity (SNCV) were evaluated by EMG assessment.The assessment of sleep quality was done by Pittsburgh sleep quality index scale (PSQI).Results There was no significant differences of baseline MNCV,SNCV and the degree of pain among the three groups (P>0.05).After treatment,all the above index were improved in both Cobamamide group and Gabapentin+Cobamamide group.MNCV and SNCV were higher in Gabapentin+Cobamamide group than in Cobamamide group (P0.05).Conclusion The combination therapy of Gabapentin and adenosine cobalt amine could reduce pain,improve nerve conduction velocity,and improve the quality of sleep.

Advances in imaging research of the central nervous system in painful diabetic neuropathy / 医学研究生学报

Painful diabetic neuropathy (PDN) seriously affects the patients′life quality, while the exact pathogenesis is un-known.Increasing number of evidences show that these patients have pathological changes of the central nervous system .Multimodal magnetic resonance imaging can noninvasively detect changes in the structure and function of the central nervous system , and become a new means to study the disease mechanisms .This article reviews the central mechanisms of PDN as well as multimodal magnetic reso -nance imaging findings that patients with PDN exist thalamic nerve dysfunction , increased thalamic blood flow , volume reduction of so-matosensory cortical gray matter , the default network and attention network destruction , and so on .

Advances in imaging research of the central nervous system in painful diabetic neuropathy / 医学研究生学报

Painful diabetic neuropathy (PDN) seriously affects the patients′life quality, while the exact pathogenesis is un-known.Increasing number of evidences show that these patients have pathological changes of the central nervous system .Multimodal magnetic resonance imaging can noninvasively detect changes in the structure and function of the central nervous system , and become a new means to study the disease mechanisms .This article reviews the central mechanisms of PDN as well as multimodal magnetic reso -nance imaging findings that patients with PDN exist thalamic nerve dysfunction , increased thalamic blood flow , volume reduction of so-matosensory cortical gray matter , the default network and attention network destruction , and so on .

Effects of Nefopam on Streptozotocin-Induced Diabetic Neuropathic Pain in Rats

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.

Effects of Nefopam on Streptozotocin-Induced Diabetic Neuropathic Pain in Rats

BACKGROUND: Nefopam is a centrally acting non-opioid analgesic agent. Its analgesic properties may be related to the inhibitions of monoamine reuptake and the N-methyl-D-aspartate (NMDA) receptor. The antinociceptive effect of nefopam has been shown in animal models of acute and chronic pain and in humans. However, the effect of nefopam on diabetic neuropathic pain is unclear. Therefore, we investigated the preventive effect of nefopam on diabetic neuropathic pain induced by streptozotocin (STZ) in rats. METHODS: Pretreatment with nefopam (30 mg/kg) was performed intraperitoneally 30 min prior to an intraperitoneal injection of STZ (60 mg/kg). Mechanical and cold allodynia were tested before, and 1 to 4 weeks after drug administration. Thermal hyperalgesia was also investigated. In addition, the transient receptor potential ankyrin 1 (TRPA1) and TRP melastatin 8 (TRPM8) expression levels in the dorsal root ganglion (DRG) were evaluated. RESULTS: Pretreatment with nefopam significantly inhibited STZ-induced mechanical and cold allodynia, but not thermal hyperalgesia. The STZ injection increased TRPM8, but not TRPA1, expression levels in DRG neurons. Pretreatment with nefopam decreased STZ-induced TRPM8 expression levels in the DRG. CONCLUSIONS: These results demonstrate that a nefopam pretreatment has strong antiallodynic effects on STZ-induced diabetic rats, which may be associated with TRPM8 located in the DRG.

Recent and emerging trends in Pharmacotherapy of neuropathic pain.

Neuropathic pain is a type of chronic pain caused by a lesion or disease of the somatosensory nervous system. The pathophysiology of neuropathic pain is very complex, not fully understood and different from that somatic pain. It has a deleterious effect on health related quality of life, and leads to increased health-care costs and its management is extremely difficult. The response to currently available treatments is less promising, so newer agents with better efficacy and safety are needed. Currently tricyclic antidepressants and anticonvulsants like gabapentin and pregabalin are considered as the 1st line drugs but these are not able to produce complete relief. Various recent drugs are: high dose capsaicin patch, topical lidocaine, botulinum toxin A, lacosamide, Selective Serotinin Reuptake inhibitorss, NMDA antagonists. Certain new targets like endocannabinoid system and various neurotrophic factors like BDNF, NT3, NT4, and GDNF are undergoing preclinical and clinical trials and their role in the treatment of neuropathic pain is still emerging.

Effects of gabapentin on plasma β-endorphin level in the patients with painful diabetic neuropathy / 中国糖尿病杂志

Objective To investigate the effects of gabapentin(GBP) on plasma β-endorphin(β-EP) level in the patients with painful diabetic neuropathy(PDN). Methods We detected the plasma β-EP level in 24 PDN patients in the treatment with GBP, 18 PDN patients without GBP treatment, 20 diabetic mellitus patients without PDN and 24 healthy control subjects. Results (1)The level of β-EP in diabetic mellitus patients was lower than in the healthy control(P<0.01). (2)The patients who received GBP had a significant change of β-EP level after treatment(P<0. 01).. Conclusions Gabapentin is effective for the treatment of PDN and its adverse effects are mild. It can lower the plasma β-EP level in the patients with PDN.