Diabetes peripheral neuropathy

Neuropathic pain is defined as spontaneous pain and hypersensitivity to pain associated with damage to or pathologic changes in the peripheral nervous system as in painful diabetic peripheral neuropathy (DPN), acquired immunodeficiency syndrome (AIDS), polyneuropathy, post-herpetic neuralgia (PHN) or pain originating in the central nervous system (CNS), that which occurs with spinal cord injury, multiple sclerosis, and stroke. Functional pain, a relatively newer concept, is pain sensitivity due to an abnormal processing or function of the central nervous system in response to normal stimuli. Several conditions considered to have this abnormal sensitivity or hyperresponsiveness include fibromyalgia and irritable bowel syndrome. 

DPN, diabetic peripheral neuropathy PHN, post-herpetic neuralgia TCA, tricyclic antidepressant. 

An excellent example for an enzymatic resolution process is reported for production of Pregabalin. This drug was approved by the US Food and Drug Administration (FDA) in 2004 against neurophatic pain associated with diabetic peripheral neuropathy and postherpetic neuralgia. Several different routes have been developed based on asymmetric hydrogenation, crystallization and biocatalytic resolutions [16-20]. The most powerful and currently applied process is based on a lipase resolution, shown in Figure 14.3. This process is one of the very few... 

Neuropathic pain associated with diabetic peripherai neuropathy For management of neuropathic pain associated with diabetic peripheral neuropathy. 

Unlabeled Uses Treatment of bipolar disorder, chronic pain, diabetic peripheral neuropathy, essential tremor, hot flashes, hyperhidrosis, migraines, psychiatric disorders (social phobia)... 

Pregabalin is approved for the adjunctive treatment of partial seizures, with or without secondary generalization controlled clinical trials have documented its effectiveness. It is available only in oral form, and the daily dose ranges from 150 to 600 mg/d, usually in two or three divided administrations. Pregabalin is also approved for use in neuropathic pain, including painful diabetic peripheral neuropathy and postherpetic neuralgia. 

The pain associated with diabetic peripheral neuropathy, trigeminal neuralgia, or cancer may predispose such patients to depression. Tricyclic antidepressants have been shown to be an effective adjunct in managing these and other similar conditions. 

Improves sleep Interference as well as pain In patients with painful diabetic peripheral neuropathy or postherpetic neuralgia... 

In studies in patients with diabetic peripheral neuropathy, adverse effects included nausea, hiccups, tremor, headache, weakness and dizziness, tachycardia, and allergic reactions (14). 

Nabulsi LH, McLendon BM, Vondracek TG. Mexiletine for diabetic peripheral neuropathy. J Pharm Technol 2000 16 8-11. 

Jamal GA, Carmichael H. The effect of gamma-linolenic acid on human diabetic peripheral neuropathy a double-blind placebo-controlled trial. Diabet Med 1990 7 319-323. 

D.F. Sahagian, G.A. Randomized double blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Arch. Intern. Med. 1999, 159 (16), 1931-1937. 

An even more promising drug is the naphthalenethiocarboxylic acid amide of N-methylglycine, tolserat (Alderase). This drug is also in clinical trials. A preliminary report of a 24-week study claimed significant improvements in patients with diabetic peripheral neuropathy. 

Leinninger G M, Vincent A M, Feldman E L (2004). The role of growth factors in diabetic peripheral neuropathy. J. Periph. Nerv. Syst. 9 26-53. 

Vinik Al, Bril V Kempler P, et al. Treatment of symptomatic diabetic peripheral neuropathy with the protein kinase C beta-inhibitor ruboxistaurin mesylate during a 1-year, randomized, placebo-controlled, double-blind clinical trial. Clin Ther 2005 27 1164-1180. 

Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of Diabetic Peripheral Neuropathy, in the US. Diabetes Care 2003 26 1790-1795. 

Hotta N, Akanuma Y, Kawamori R et al. Long-term clinical effects of Epakestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy. Diabetes Care 2006 29(7) 1538-1544. 

Boulton AJM. Management of diabetic peripheral neuropathy. Clin Diab. 2005 23(1) 9-15. 

Griesing T, Freeman R Rosenstock et al. Efficacy, safety and tolerability og pregabalin treatment for diabetic peripheral neuropathy findings from 6 randomized controlled trials. Diabetologia 2005 48 (suppl 1) A351. 

Tesfaye, S. 2009. Advances in the management of diabetic peripheral neuropathy. Curr. 

Rauck RL, Shaibani A, Biton V, Simpson J, Koch B. Lacosamide in painful diabetic peripheral neuropathy a phase 2 double-blind placebo-controlled study. Chn J Pain 2007 23(2) 150-8. 

Neuropathic pain associated with diabetic peripheral neuropathy... 

RCT, randomized controiied triai with positive resuits MA, metaanalysis of RCTs with positive resuits OA, osteoarthritis CLBP, chronic low back pain FMS, fibromyaigia syndrome Diabetic PN = diabetic peripheral neuropathy PHN, post-herpetic neuraigia Painfui polyneur, painful polyneuropathy n.t, not tested Neg., negative results in 2 1 RCT Contra, contradictory evidence. 

Diabetic peripheral neuropathic pain the effectiveness of duloxetine must be assessed carefully based on the progress of diabetic peripheral neuropathy. 

The efficacy of duloxetine in pain management of diabetic peripheral neuropathy was recognized in two randomized, 12-week, double-blind, placebo-controlled, fixed-dose studies. These were adult patients with at least 6 months history of peripheral neuropathic pain due to diabetes. 

The efficacy of tapentadol ER in managing moderate to severe chronic pain was also evaluated in patients with diabetic peripheral neuropathy [7,8]. A recent phase 111 randomized-withdrawal trial evaluated diabetic patients aged 18 years or older with a diagnosis of moderate-severe painful diabetic peripheral neuropathy and symptoms for a minimum of 6 months [7]. 

Sandercock D, Cramer M, Wu J, Chiang YK, Biton V, Heritier M. Gabapentin extended release for the treatment of painful diabetic peripheral neuropathy efficacy and tolerability in a double-blind, randomized, controlled clinical trial. Diabetes Care 2009 32(2) e20. 

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