Painful Diabetic Neuropathy in Clinical Practice

71 Pages·2011·2.412 MB·English

by  Boulton, Andrew J. M.;Vileikyte, Loretta

Painful Diabetic Neuropathy
in Clinical Practice

Andrew J.M. Boulton
Loretta Vileikyte
Painful Diabetic
Neuropathy in
Clinical Practice
Authors
Andrew J.M. Boulton, MD, FRCP Loretta Vileikyte, MD, PhD
Professor of Medicine Senior Lecturer
University of Manchester University of Manchester
Manchester, UK and Manchester, UK and
Diabetes Research Institute University of Miami
University of Miami Miami, FL, USA
Miami, FL, USA
ISBN 978-0-85729-487-6 e-ISBN 978-0-85729-488-3
DOI 10.1007/978-0-85729-488-3
Springer London Dordrecht Heidelberg New York
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library
Library of Congress Control Number: 2011927072
© Springer-Verlag London Limited 2011
This is a revised and expanded edition of Boulton and Vileikyte’s Managing
Neuropathic Pain in the Diabetic Patient, 2nd edition, published by Current Medicine
Group, now Springer Healthcare Communications Ltd., in 2009.
Apart from any fair dealing for the purposes of research or private study, or criti-
cism or review, as permitted under the Copyright, Designs and Patents Act 1988,
this publication may only be reproduced, stored or transmitted, in any form or by
any means, with the prior permission in writing of the publishers, or in the case of
reprographic reproduction in accordance with the terms of licenses issued by the
Copyright Licensing Agency. Enquiries concerning reproduction outside those
terms should be sent to the publishers.
The use of registered names, trademarks, etc., in this publication does not imply,
even in the absence of a specific statement, that such names are exempt from the
relevant laws and regulations and therefore free for general use.
Product liability: The publisher can give no guarantee for information about drug
dosage and application thereof contained in this book. In every individual case the
respective user must check its accuracy by consulting other pharmaceutical
literature.
Cover design: eStudioCalamar, Figueres/Berlin
Printed on acid-free paper
Springer is part of Springer Science+Business Media (www.springer.com)
About the Authors
Andrew J.M. Boulton, MD, FRCP, is Professor of Medicine
at the Manchester Royal Infirmary and Visiting Professor at
the University of Miami, USA. Among his many awards, his
contribution to worldwide care of the diabetic foot was hon-
oured by receiving the American Diabetic Association’s
Roger Pecoraro Lectureship and the European Association
for the Study of Diabetes (EASD) Camillo Golgi prize, and
he was the first recipient of the international award on dia-
betic foot research. In 2008 he was awarded the Harold
Rifkin prize of the ADA for distinguished international ser-
vice in the cause of diabetes and the first outstanding achieve-
ment award of the American Professional Wound Care
Association. Professor Boulton was the founding Chairman
of the Diabetic Foot Study Group and was previously
Chairman of Postgraduate Education and then programme
chair for the EASD. He is renowned worldwide as a leading
educator and lecturer on neuropathy and the diabetic foot.
He is the global chairman of the Diabetes Lower Extremity
Research Group (DIALEX). Professor Boulton chaired the
ADA’s expert group on diabetic neuropathy that resulted in
the April 2005 ADA statement on diabetic neuropathy, and
was chair of the ADA Foot Council 2005–2007. He is a mem-
ber of the editorial review board for Diabetes/Metabolism:
Research and Reviews, Acta Diabetologica, Diabetes Care,
The Diabetic Foot and International Diabetes Monitor.
Professor Boulton has authored more than 350 peer-reviewed
manuscripts and book chapters, mainly on diabetic neuropa-
thy and foot complications.
v
vi About the Authors
Loretta Vileikyte, MD, PhD., is Senior Lecturer at the University
of Manchester and visiting Assistant Professor of Medicine at
the University of Miami, USA. Her main research interests lie
in the psychosocial aspects of the lower limb complications of
diabetes and she developed the first neuropathy-specific qual-
ity-of-life scale that has been used in several clinical trials of
new medications for painful diabetic neuropathy. She previ-
ously held the first joint American and British Diabetes
Association grant to develop a scale to assess patients’ cogni-
tive and emotional representations of neuropathy and is cur-
rently funded by the National Institutes of Health (NIH) to
study the effects of stress on wound healing in diabetic neuro-
pathic foot ulceration.
Contents
1 Introduction to Diabetic Neuropathies ........... 1
Definition .................................... 1
Epidemiology and Natural History............... 2
Incidence and Prevalence ................. 2
Risk Factors............................. 3
Natural History.......................... 4
References ................................... 4
2 Classification and Clinical Features............... 7
Classification ................................. 7
Sensory Neuropathies.......................... 8
Chronic Sensorimotor Distal
Symmetrical Polyneuropathy .............. 8
Acute Sensory Neuropathy................ 11
The Effects of Painful Neuropathic
Symptoms on Negative Affect
and Quality of Life....................... 13
Focal and Multifocal Neuropathies............... 15
Mononeuropathies....................... 15
Cranial Neuropathies..................... 17
Diabetic Amyotrophy .................... 17
Diabetic Truncal Radiculoneuropathy....... 18
Chronic Inflammatory Demyelinating
Polyneuropathy.......................... 18
Autonomic Neuropathy ........................ 19
References ................................... 21
vii
viii Contents
3 Diagnosis and Staging.......................... 23
Patient History................................ 23
Patient Description of Pain ..................... 25
Positive and Negative Sensory Symptoms ......... 26
Assessment Scales............................. 27
Visual Analogue and Verbal
Descriptor Scales ........................ 27
Likert Scales ............................ 28
McGill Pain Questionnaire................ 28
Brief Pain Inventory...................... 28
Neuropathic Pain Scale ................... 28
Leeds Assessment of Neuropathic
Symptoms and Signs Pain Scale ............ 29
NeuroQoL.............................. 29
Other Assessment Scales.................. 29
Clinical Examination........................... 30
Quantitative Sensory Testing . . . . . . . . . . . . . . . . . . . . 30
Electrophysiological Testing..................... 33
Diagnosing Cardiovascular
Autonomic Neuropathy ........................ 33
Staging of Neuropathy ......................... 35
When to Refer to a Neurologist.................. 36
References ................................... 37
4 Management of Neuropathic Pain................ 41
Metabolic Control............................. 41
Pharmacological Treatments .................... 43
Tricyclic Antidepressants.................. 43
Selective Serotonin Reuptake Inhibitors .... 45
Serotonin and Noradrenaline
Reuptake Inhibitors...................... 45
Anticonvulsants ......................... 46
Local Anaesthetic/Anti-arrhythmic
Agents ................................. 47
Opioids................................. 48
Comparative Trials....................... 49
Contents ix
Topical Treatments ............................ 49
Capsaicin............................... 50
Lidocaine Patches........................ 50
Isosorbide Dinitrate Spray ................ 50
Non-pharmacological Treatments ................ 51
Acupuncture............................ 51
Electrical Therapy ....................... 51
Treatment of Cardiovascular
Autonomic Neuropathy ........................ 52
Guidelines on the Pharmacological Treatment
of Diabetic Neuropathic Pain.................... 52
References ................................... 54
Index ........................................... 59