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    Diabetic Peripheral Neuropathic Pain (DPNP)

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    gjgibson2784
    This document provides an overview of diabetic peripheral neuropathic pain (DPNP). It defines DPNP as a type of pain that can occur in 10-20% of patients with diabetes as a result of damage to peripheral nerves. The document reviews symptoms and signs of DPNP, potential metabolic pathways that may contribute to its development, definitions of pain from medical organizations, and the physiology of pain perception through ascending and descending neural pathways in the body.

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    Diabetic Peripheral Neuropathic Pain (DPNP)

    Uploaded by

    gjgibson2784
    46 views11 pages
    This document provides an overview of diabetic peripheral neuropathic pain (DPNP). It defines DPNP as a type of pain that can occur in 10-20% of patients with diabetes as a result of damage to peripheral nerves. The document reviews symptoms and signs of DPNP, potential metabolic pathways that may contribute to its development, definitions of pain from medical organizations, and the physiology of pain perception through ascending and descending neural pathways in the body.

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    This document provides an overview of diabetic peripheral neuropathic pain (DPNP). It defines DPNP as a type of pain that can occur in 10-20% of patients with diabetes as a result of damage to peripheral nerves. The document reviews symptoms and signs of DPNP, potential metabolic pathways that may contribute to its development, definitions of pain from medical organizations, and the physiology of pain perception through ascending and descending neural pathways in the body.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    46 views11 pages

    Diabetic Peripheral Neuropathic Pain (DPNP)

    Uploaded by

    gjgibson2784
    This document provides an overview of diabetic peripheral neuropathic pain (DPNP). It defines DPNP as a type of pain that can occur in 10-20% of patients with diabetes as a result of damage to peripheral nerves. The document reviews symptoms and signs of DPNP, potential metabolic pathways that may contribute to its development, definitions of pain from medical organizations, and the physiology of pain perception through ascending and descending neural pathways in the body.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 11

    Diabetic Peripheral Neuropathic Pain

    (DPNP)
    Appropriate Use Statement

    This Medical Slide Set is intended to be used as a template and may be modified for use in
    your country, but must comply with your local medical, legal, and regulatory guidelines . The
    content has been organized into a modular format to make searching for specific data more
    efficient and updating modules more organized. It should not be presented in its entirety,
    but rather select slides should be chosen for particular audiences and messages. While the
    titles and supportive text can be translated to meet local needs, graphic representations of
    the data should remain intact.
     
    Each affiliate/OPU is responsible for approving the slides through their own local Medical,
    Legal and Regulatory review process (or other appropriate processes) depending on the
    intent of the presentation prior to use with external customers.
    Disease State Review:

    Diabetic Peripheral Neuropathy


    Diabetic Peripheral Neuropathy Defined

    Diabetic Peripheral Neuropathy (DPN):


    “the presence of symptoms and/or signs of
    peripheral nerve dysfunction in people with
    diabetes after the exclusion of other causes”

    Boulton AJ, et al. Diabet Med 1998;15:508-514.


    Peripheral Neuropathy and Neuropathic Pain Are
    Frequent Complications of Diabetes

     30 to 60% of patients with diabetes may have


    diabetic peripheral neuropathy (DPN)1
    • Similar rates in type 1 and type 2 diabetes
    • Increased risk with longer duration of diabetes and with
    poor glucose control

     10% to 20% of patients with diabetes may


    experience diabetic peripheral neuropathic pain
    (DPNP)2, 3
     30% to 60% of patients with DPN may have
    DPNP2, 4
    1. Eastman RC. Neuropathy in Diabetes. In: Diabetes in America, 2nd ed; NIH Publication No. 95-1468; 1995, pp. 339-347.
    2. Dyck PJ, et al. Neurology 1993;43:817-824. 4. Boulton AJM, et al. Diabetes Care 2004;27:1458-1486.
    3. Ziegler D, et al. J Diabetes Complications 1992;6:49-57.
    Symptoms and Signs of
    Diabetic Peripheral Neuropathy
    Distal symmetrical sensorimotor polyneuropathy
    is the most common form of DPN.
    Symptoms Signs
     Numbness or loss of feeling  Diminished vibratory perception
    (asleep or “bunched up sock  Decreased knee and ankle
    under toes” sensation) reflexes
     Prickling/Tingling  Reduced protective sensation
     Aching Pain such as pressure, hot and cold,
     Burning Pain pain
     Lancinating Pain  Diminished ability to sense
    position of toes and feet
     Unusual sensitivity or
    tenderness when feet are
    touched (allodynia)
    Symptoms and signs
    progress from distal
    to proximal over time
    Multiple Metabolic Pathways May Contribute to
    Diabetic Polyneuropathy
    Diabetes

    Hyperglycemia

    PKC- Oxidative stress Glycation Polyol Pathway

    Direct neurotoxicity Vasculopathy / ischemia

    Diabetic neuropathy
    Adapted from: Boulton AJM, et al. Diabetes Care 2004;27:1458-1486.
    Disease State Review:

    Diabetic Peripheral Neuropathic Pain


    International Association for the Study of Pain
    (IASP): Definition of Pain

    “Pain is an unpleasant sensory and emotional


    experience associated with actual or potential
    tissue damage or described in terms of such
    damage.”

    IASP Task Force on Taxonomy. In: Merskey H, Bogduk N, eds. Classification of Chronic Pain, 2nd ed. Seattle, WA: IASP
    Press; 1994, pp. 209-214.
    Multiple Types of Pain
    A. Nociceptive Pain Noxious
    Peripheral Brain
    Stimuli Nociceptor Sensory
    Neuron

    Inflammation
    B. Inflammatory/Joint Brain
    Tissue Nociceptor Sensory
    Related Pain
    Damage Neuron

    C. Neuropathic Pain Brain


    Peripheral Nerve
    Damage
    Multiple Mechanisms

    D. Noninflammatory/ Brain
    Non-neuropathic Pain Normal Peripheral
    Tissue and Nerves
    Abnormal Central Processing

    Adapted from: Woolf C. Ann Intern Med 2004;140:441-451.


    Physiology of Pain Perception: Ascending and
    Descending Neural Pathways
    Somatosensory cortex
    Limbic forebrain system

    Hypothetical descending
    cortical neurons
    Intralaminar
    Descending thalamic nucleus
    Pathways Periaqueductal gray area Ventroposterolateral
    thalamic nucleus
    Reticular Ascending
    Dorsolateral pontine formation Pathways
    tegmentum (NE) Neospinothalamic tract
    Rostroventral Paleospinothalamic tract
    medulla (5-HT)
    Spinoreticular tract

    Dorsal root
    ganglion

    A fiber

    A fiber

    C fiber

    Figure adapted from: Alpay M. Pain Patients. In: Stern TA, et al. Massachusetts General Hospital Handbook of General
    Hospital Psychiatry , 5th ed. Philadelphia, PA: CV Mosby; 2004, p. 314.

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