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Diabetic Peripheral Neuropathic Pain
Diabetic Peripheral Neuropathic Pain (DPNP) affects an estimated 10-20% of the more than 20 million people in the USA who have diabetes mellitus (DM). The pain can be severe and can markedly interfere with functioning. Although there is no cure for DPNP, for many patients the pain can be controlled to a degree sufficient to improve their quality of life. SymptomsDiabetic Peripheral Neuropathic Pain is most commonly described as a burning or electric shock sensation and is usually located in the feet and lower limbs, although the hands may be affected as well. Patients may also experience allodynia, in which ordinarily non-painful stimuli is increased. Even when patients are experiencing pain, they may also feel numbness over the affected area. Although patients with lower extremity pain usually report that placing weight on their feet exacerbates the pain, DPNP frequently worsens at night. This can cause sleep disorders. Insomnia has been associated with abnormal glucose-tolerance-test results and may precipitate diabetes mellitus.
EvaluationDPNP is the most likely diagnosis in a patient with DM who has foot or lower limb pain. A 2-hour oral glucose-tolerance test is recommended for patients who have this type of pain, but who have not yet been evaluated for DM. However there are other potential causes of peripheral pain that should be considered, including pain related to vitamin B12 deficiency, claudication and osteoarthritis. These causes can usually be differentiated from DPNP by appropriate testing.Neurological studies, such as nerve conduction velocity and quantitive sensory tests, usually demonstrate a reduction in functioning of the peripheral nerves in patients with DPNP. However there is minimal correlation between the results of these tests and the prescence or severity of DPNP; thus, they provide limited assistance in making the diagnosis. These tests should not routinely be ordered for patients who are believed to have DPNP. Article Resource : Dr King (Clinical Professor at New York University School of Medicine) |