Therapeutic alternatives in painful diabetic neuropathy: a meta-analysis of randomized controlled trials

BACKGROUND: One of the most frequent problems caused by diabetes is the so called painful diabetic neuropathy. This condition can be treated through numerous types of therapy. The purpose of this study was to analyze, as a meta-analysis, different treatments used to alleviate painful diabetic neuropathy, with the aim of generating results that help making decisions when applying such treatments to tackle this pathology. METHODS: A search was conducted in the main databases for Health Sciences, such as PUBMED, Web of Science (WOS), and IME biomedicina (Spanish Medical Reports in Biomedicine), to gather randomized controlled trials about treatments used for painful diabetic neuropathy. The analyzed studies were required to meet the inclusion criteria selected, especially those results related to pain intensity. RESULTS: Nine randomized controlled trials were chosen. The meta-analysis shows significant positive effects for those treatments based on tapentadol [g: −1.333, 95% CI (−1.594; −1.072), P < 0.05], duloxetine [g: −1.622, 95 % CI (−1.650; −1.594), P < 0.05], pregabalin [g: −0.607, 95% CI (−0.980; −0.325), P < 0.05], and clonidine [g: −0.242, 95 % CI (−0.543; −0.058), P < 0.05]. CONCLUSIONS: This meta-analysis indicates the effectiveness of the treatments based on duloxetine, gabapentin and pregabalin, as well as other drugs, such as tapentadol and topic clonidine, whose use is better prescribed in more specific situations. The results provided can help increase the knowledge about the treatment of painful diabetic neuropathy and also in the making of clinical practice guidelines for healthcare professionals.

Asimetrías faciales como factor etiopatogénico de cefaleas y dolor facial / Facial asymmetries as etiopathogenic factors of headache and facial pain

El objetivo de este estudio fue demostrar la hipótesis sobre la coexistencia de asimetría morfológica con actividad muscular asimétrica, y deesta última con disfunción cráneomandibular y cefalea tensional y dolor facial, para incorporar datos semiológicos al diagnóstico tempranoy tratamiento precoz de las disfunciones cráneo-cérvico mandibulares. Participaron del estudio 66 alumnos de la F.O.U.B.A. con signos y/o síntomas de disfunción cráneomandibular. El diagnóstico de dolor se realizó mediante cuestionarios siguiendo los criterios diagnósticos de la Internacional Headache Society. La determinación de asimetría se realizó midiendo segmentos y ángulos trazados en telerradiografíade frente para tejidos duros y fotografía de cara de frente para tejidos blandos. Se evaluó la función muscular mediante electromiografía de superficie (EMGS); y la dinámica del sistema estomatognático mediante el método magnetométrico. El análisis de regresión logística múltiple resultó significativo al nivel p=0.01. En el análisis de las variables individuales y el dolor se encontró correlación estadísticamente significativa entre la asimetría de tejidos duros y la presencia de cefalea tensional y/o dolor facial. El organismo intenta equilibrar las diferencias morfológicas, esto explicaría las asimetrías cruzadas entre tejidos duros, blandos y actividad muscular comocompensaciones funcionales. Concluimos diciendo que ante la presencia de cefalea tensional y/o dolor facial debemos considerar la asimetríafacial de tejidos duros como posible factor etiológico predisponente aunque no se observe asimetría en tejidos blandos por acción compensatoria de la dinámica muscular. La etiología mixta, oclusal y postural, de las asimetrías faciales requiere del trabajo interdisciplinario odontólogo-médico-kinesiólogo-psicólogo-fonoaudiólogo para un óptimo diagnóstico y tratamiento

The aim of this study was to test the hypothesis on the coexistence of morphological asymmetry with asymmetric muscle activity, and this one with craniomandibular dysfunction and tension headache and facial pain, to incorporate semiological data to early diagnosis and treatment for TMJD (temporo mandibular jaw dysfunction). Study participants were 66 students from the Faculty of Dentistry of the University of Buenos Aires with TMJD signs and / or symptoms. The diagnosis of pain was conducted by questionnaires following the diagnostic criteria of the International Headache Society. The asymmetry determination was performed by measuring segments and angles in cephalometric frontal tracings for hard tissues and frontal picture for soft tissues. Muscle function was evaluated by surface electromyography (SEMG) and stomatognathic system dynamics by magnetometric method. The multiple logistic regression analysis was significant at p = 0.01. In the analysis of individual variables and pain we found statistical correlation between the asymmetry of hard tissues and the presence of tension headache and / or facial pain. The body tries to balance the morphological differences; this would explain the asymmetries cross between hard tissues, soft and functional muscle activity as offsets. We conclude saying that in the presence of tension headache and/or facial pain, the hard tissue facial asymmetry should be considered as a possible etiologic factor predisposing even asymmetry is not observed in soft tissue because of compensatory action of muscle dynamics. The mixed etiology, occlusal and postural of the facial asymmetries, requires interdisciplinary work dentist-doctor-physiotherapist,-psychologist-speech therapist, for optimal diagnosis and treatment.