Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands.
Department of Anesthesiology and Pain Management, Diakonessenhuis Utrecht/Zeist, Utrecht, The Netherlands.
Pain Pract. 2024 Feb;24(2):308-320. doi: 10.1111/papr.13308. Epub 2023 Oct 19.
Pain as a symptom of diabetic polyneuropathy (DPN) significantly lowers quality of life, increases mortality and is the main reason for patients with diabetes to seek medical attention. The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades.
The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized.
The etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra-spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain-phenotyping and genotyping based on patient-specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of "probable PDPN" is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism-based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and/or radiofrequency ablation (SLCN/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise.
The diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.
糖尿病性多发性神经病（DPN）的疼痛症状显著降低了生活质量，增加了死亡率，也是糖尿病患者寻求医疗关注的主要原因。在过去几十年中，患有痛性糖尿病多发性神经病（PDPN）的人数显著增加。
检索并总结了关于糖尿病性多发性神经病的诊断和治疗的文献。
PDPN 的病因复杂，外周伤害感受器的原发性损伤以及脊髓和脊髓上调节的改变。为了获得更好的患者结局，PDPN 的诊断和治疗方式朝着基于患者个体特征、新的诊断工具以及对药物治疗的先前反应进行更精确的疼痛表型和基因分型的方向发展。根据多伦多糖尿病神经病变专家组的建议，对“可能的 PDPN”进行推定诊断足以启动治疗。适当控制血糖水平和预防危险因素是治疗 PDPN 的关键。应尽早开始基于机制的药物治疗。如果症状性药物治疗失败，应考虑脊髓刺激（SCS）。在孤立的情况下，如果症状性药物治疗和 SCS 不成功或无法使用，则可以考虑交感神经腰椎链神经松解术和/或射频消融术（SLCN/SLCRF）、背根神经节刺激（DRGs）或胫后神经刺激（PTNS）。但是，建议仅在专门中心的研究环境中应用这些治疗方法。
PDPN 的诊断朝着表型和基因型发展，治疗应基于机制。
