Primary care has an increasing role in the diagnosis and treatment of painful diabetic neuropathy (PDN), and early accurate diagnosis and intervention can greatly improve the prognosis. With the incidence of diabetes predicted to increase dramatically, the number of patients with PDN is set to soar. PDN can have a serious impact on quality of life, leading to severe depression and even suicide. The evolution of a schematic approach to the diagnosis and treatment of PDN can offer new hope to many patients. This review focuses on PDN and current treatment strategies. Many leading pain clinics have adopted a multidisciplinary approach to the pharmacological and non-pharmacological management of PDN.
Amos AF, McCarty DJ, Zimmet P.The rising global burden of Diabetes and its complications: estimates and projections to the year 2010. Diabet Med1997 ;14:S7-S85.
Vinik AI, Park TS, Stansberry KB, Pittenger GLDiabetic Neuropathies. Diabetologia2000;43:957-73.
4.
Young MJ, Boulton AJ, MacLeod AF et al. A multicentre study of the prevalence of peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia1993;36:150-4.
5.
UK Prospective Diabetes Study Group.Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type II diabetes. Lancet1998; 352:837-53.
6.
Dyck PJ, Kratz KM, Karnes JL et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: The Rochester Diabetic Neuropathy Study. Neurology1993;43:817-24.
7.
Tesfaye S., Stevens LK, Stephenson JM et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia1996;39: 1377-84.
8.
Chan AW, MacFarlane IA, Bowsher DR et al. Chronic pain in patients with diabetes mellitus: comparison with non-diabetic population. The Pain Clinic1990;3:147-59.
9.
Zeigler D., Greies AF, Spooler M. et al. The epidemiology of diabetic neuropathy. The J Diab Complic1992;6:49-57.
10.
Consensus Statement Report and Recommendations of the San Antonio Conference on Diabetic Neuropathy. Diabetes1988;37:1000-04.
11.
Greene DA, Stevens MJ, Feldman ELDiabetic neuropathy: scope of the syndrome. Am J Med1999;107:S2-7.
12.
Thomas PKMetabolic neuropathy. J R Coll Physicians Lond1973;7:154-60.
13.
Levitt NS, Stansberry KB, Wychanck S., Vinik AINatural progression of autonomic neuropathy and autonomic function test in a cohort of IDDM. Diabetes Care1996 ;19: 751-4.
14.
Dyck PJ, Giannini C.Pathologic alterations in the diabetic neuropathies of humans: a review . J Neuropathol Exp Neurol1996;55: 1181-93.
15.
Thomas PKMonitoring the natural history and results of therapeutic intervention in diabetic neuropathy: clinical measures. Electroencephalog. Clin Neurophysicol1999;50:521-4.
16.
Gureje O., Von Korff M., Simon GE, Gater R.Persistent pain and well-being: a World Health Organisation Study in primary care. JAMA1998;280:147-51.
Tesfaye S., Malik R., Harris N. et al. Arteriovenious shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). Diabetologia1996;39:329-35.
19.
Young MJ, Breddy JL, Boulton AJM.The prediction of diabetic foot ulceration using vibration perception thresholds: a perception study. Diabetes Care1994;17:557-60.
20.
Bennett M.The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs . Pain2001;92:147-57.
21.
Melzack R.The McGill Pain Questionnaire: major properties and scoring methods . Pain1975;1:277-99.
22.
Scott J., Huskisson ECGraphic representation of pain. Pain1976;2:175-84.
23.
Galer BS, Jensen M.Development and preliminary validation of a pain measure specific to neuropathic pain: the neuropathy pain scale. Neurology1997;48:332-9.
24.
Ziegler D., Hanefeild M., Ruhnau KJ et al. Treatment of symptomatic diabetic peripheral neuropathy with the anti-oxidant alphalipoic acid. A three week multicentre randomised controlled trial (ALADIN study). Diabetologia1995;38:1425-33.
25.
Dyck PJDetection, characterisation, and staging of polyneuropathy. Muscle Nerve1988;11:21-32.
26.
Vileikyte L. , Bundy C., Tomenson B., Walsh B., Boulton AJM.Neuropathy-specific quality of life measure: construction of scales and preliminary tests of reliability and validity. Diabetes1998;47:A44.
27.
Bradley C., Todd C., Gorton T., Symonds E., Martin A., Plowright R.The development of an individualized questionnaire measure of perceived impact of diabetes on quality of life: the ADDQoL. Qual Life Res1999;8:79-91.
28.
Max MB, Culnane M., Schafer SC et al. Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. Neurology1987 ;37:589-96.
29.
UK Prospective Diabetes Study Group (UKPDS 38). Tight blood pressure control and risk of macro and microvascular complications in type 2 diabetes. BMJ1998 ;317: 703-13.
30.
Backonja M. , Beydoun A., Edwards KR et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA1998;280:1831-6.
31.
Spruce MC, Potter J., Coppini DVThe pathogenesis and management of painful diabetic neuropathy: a review. Diabet Med2003; 20:88-98.
32.
Dejgard A., Petersen P., Kastrup J.Mexiletine for the treatment of chronic painful diabetic neuropathy . Lancet1988:1(8575-6):9-11.
33.
Harati Y., Gooch C., Swenson M. et al. Maintenance of the long-term effectiveness of Tramadol in treatment of the pain of diabetic neuropathy. J Diabetes Complications2000;14:65-70.
34.
Abuaesha BB , Costanzi JB, Boulton AJM.Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy: a long-term study. Diabetes Res Clin Pract1998;39:115-21.
