PEEP

Painful Diabetic Peripheral Neuropathy (PDPN)

Painful Diabetic Peripheral Neuropathy (PDPN) is a common complication of diabetes mellitus, characterized by nerve damage due to prolonged high blood sugar levels. This condition primarily affects the peripheral nerves, leading to pain, tingling, and numbness, most commonly in the feet and hands.

Pathophysiology

PDPN results from chronic hyperglycemia, which leads to metabolic and vascular changes that damage peripheral nerves. The exact mechanisms include:

• Polyol Pathway Activation: Excess glucose is converted to sorbitol and fructose, leading to osmotic and oxidative stress.
• Advanced Glycation End-products (AGEs): High glucose levels cause proteins to become glycated, altering their function and structure.
• Oxidative Stress: Increased production of reactive oxygen species (ROS) damages nerve cells.
• Microvascular Damage: Hyperglycemia causes damage to the small blood vessels that supply nerves, leading to ischemia and nerve damage.

Clinical Presentation

Patients with PDPN typically present with:

• Pain: Burning, stabbing, or shooting pain, often worse at night.
• Paresthesia: Tingling or "pins and needles" sensation.
• Numbness: Loss of sensation, which can lead to unnoticed injuries.
• Allodynia: Pain from stimuli that are not normally painful.

Diagnosis

Diagnosis of PDPN is primarily clinical, based on patient history and physical examination. Key diagnostic steps include:

• Neurological Examination: Assessing reflexes, sensation, and strength.
• Nerve Conduction Studies: To evaluate the function of peripheral nerves.
• Quantitative Sensory Testing: To assess sensory nerve function.

Management

Management of PDPN involves both pharmacological and non-pharmacological approaches:

• Glycemic Control: Tight control of blood glucose levels to prevent further nerve damage.
• Pharmacotherapy:

 * Antidepressants: Such as duloxetine and amitriptyline.
 * Anticonvulsants: Such as pregabalin and gabapentin.
 * Opioids: Tramadol or tapentadol for severe pain.

• Non-Pharmacological:

 * Physical Therapy: To improve mobility and reduce pain.
 * Transcutaneous Electrical Nerve Stimulation (TENS): For pain relief.

Prognosis

PDPN is a chronic condition that can significantly impact quality of life. Early diagnosis and management are crucial to prevent progression and complications.

Prevention

Preventive strategies focus on maintaining optimal blood glucose levels and regular monitoring for early signs of neuropathy.

Also see

• Diabetes Mellitus
• Peripheral Neuropathy
• Chronic Pain Management
• Glycemic Control

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External links

• Comprehensive information from the National Institute of health.
  

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