Chang Min Cheol, Yang Seoyon
Department of Physical Medicine and Rehabilitation, College of Medicine, Yeungnam University, Taegu, South Korea.
Department of Rehabilitation Medicine, School of Medicine, Ewha Woman's University Seoul Hospital, Seoul, South Korea.
Ann Palliat Med. 2023 Mar;12(2):390-398. doi: 10.21037/apm-22-693. Epub 2023 Feb 8.
Painful diabetic peripheral neuropathy (DPN) affects approximately 6-34% of all patients with diabetes. DPN-induced pain reduces the quality of life and makes daily activities difficult. Distal symmetric polyneuropathy (DSPN) is the most common type of DPN. Here we review the pathophysiology, diagnosis, and treatment of DPN.
A MEDLINE database (PubMed) search was conducted for English-language articles dealing with the effect of DPN that were published until April 1, 2022. To identify potentially relevant articles, the following key search phrases were combined: 'diabetes mellitus', 'diabetes', 'neuropathy', 'polyneuropathy', 'diabetic neuropathies', 'peripheral neuropathy', 'diabetic polyneuropathy', 'pathophysiology', 'diagnosis', and 'treatment'.
In a biopsy study of the sural nerve, damage to C and Aδ fibers were seen in patients who had recent onset of pain in their feet consisting of tingling, burning, and prickling, followed by initial demyelination/remyelination of large fibers. DPN is characterized by a pattern of distal-to-proximal axonal loss with symptoms. Hyperglycemia and dyslipidemia are the primary causes of DPN in patients with type 1 and 2 diabetes, respectively. The pattern of pain from DPN is described as "glove and stocking". DPN-induced pain is described as burning, electric, sharp, and dull aching with various pain intensities. DPN is a diagnosis of exclusion; diagnosis is made with a thorough medical history, physical examination, and clinical testing to rule out other causes of pain. Anticonvulsants (pregabalin and gabapentin), antidepressants (duloxetine, venlafaxine, and amitriptyline), opioids (tramadol, tapentadol, and oxycodone), and topical capsaicin are commonly administered to treat DPN. The combination of two or three of these pharmacological agents better resolves pain at lower doses and with fewer side effects.
Clinicians should have sufficient knowledge of DPN to ensure its accurate diagnosis and appropriate treatment. This review provides clinicians with the necessary knowledge of the pathophysiology, diagnosis, and treatment of painful DPN.
疼痛性糖尿病周围神经病变（DPN）影响约6% - 34%的糖尿病患者。DPN所致疼痛会降低生活质量并使日常活动变得困难。远端对称性多发性神经病变（DSPN）是DPN最常见的类型。在此，我们综述DPN的病理生理学、诊断及治疗。
在MEDLINE数据库（PubMed）中检索截至2022年4月1日发表的关于DPN影响的英文文章。为识别潜在相关文章，将以下关键检索词组合：“糖尿病”“糖尿病”“神经病变”“多发性神经病变”“糖尿病性神经病变”“周围神经病变”“糖尿病性多发性神经病变”“病理生理学”“诊断”及“治疗”。
在一项腓肠神经活检研究中，近期足部出现刺痛、灼痛和刺痛感的患者可见C纤维和Aδ纤维受损，随后大纤维出现初始脱髓鞘/再髓鞘化。DPN的特征是伴有症状的从远端到近端的轴突丢失模式。高血糖和血脂异常分别是1型和2型糖尿病患者发生DPN的主要原因。DPN的疼痛模式被描述为“手套和袜套样”。DPN所致疼痛被描述为灼痛、电击样痛、刺痛和钝痛，疼痛强度各异。DPN是一种排除性诊断；通过全面的病史、体格检查和临床检测来排除其他疼痛原因以做出诊断。抗惊厥药（普瑞巴林和加巴喷丁）、抗抑郁药（度洛西汀、文拉法辛和阿米替林）、阿片类药物（曲马多、他喷他多和羟考酮）以及局部辣椒素常用于治疗DPN。这些药物中的两种或三种联合使用能以更低剂量、更少副作用更好地缓解疼痛。
临床医生应具备足够的DPN知识以确保准确诊断和恰当治疗。本综述为临床医生提供了疼痛性DPN的病理生理学、诊断及治疗的必要知识。
