Key Points
ÎPathogenesis of diabetic peripheral neuropathic pain (DPNP) in diabetic peripheral neuropathy (DPN) is unknown, but is distinct in its apparent association with glucose-related metabolic changes of diabetes mellitus (DM). However, the underlying source of pain may be something other than DM
ÎMost patients with DPN do not experience pain and many have a lack of sensation (touch, heat, pain)
ÎPrevalence of neuropathic symptoms increases with duration of DM, with highest rates among patients who have had the disease for at least 25 years
ÎIntensive glucose control (maintenance of A1c
particularly when instituted early in DM, delays or prevents clinically manifest DPN
≤ 7 g/dL),
ÎDiagnosis of DPNP relies heavily on a thorough physical examination and patient history along with clinical judgment, rather than on any particular neurologic test or finding (can confirm presence of a neuropathy, but cannot identify underlying causes)
ÎAbsence of symptoms should not be equated with absence of neuropathy, so monitoring for neuropathy should be a regular part of clinical care of patients with DM
ÎDPNP symptoms may be difficult for a patient to describe, and caregivers should not try to interpret a patient's descriptors
ÎThere is no cure for DPN. Pharmacotherapy can only treat symptoms of DPNP
ÎGoals for treating DPNP:
> Reduction of pain for maximum relief commensurate with acceptable side effects
> Restoration/improvement in functional measures and quality of life
ÎPatients with DPNP may share some comorbidities with those having chronic pain, requiring:
> Psychological/psychiatric referral for depression > Multidisciplinary pain center referral for psychosocial therapy, biofeedback, physical therapy
ÎThere is no good evidence for efficacy of complementary or alternative therapies
