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Lin Z, Wang S, Cao Y, Lin J, Sun A, Huang W, Zhou J, Hong Q. Bioinformatics and validation reveal the potential target of curcumin in the treatment of diabetic peripheral neuropathy. Neuropharmacology 2024; 260:110131. [PMID: 39179172 DOI: 10.1016/j.neuropharm.2024.110131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Revised: 08/18/2024] [Accepted: 08/20/2024] [Indexed: 08/26/2024]
Abstract
Diabetic peripheral neuropathy (DPN) is a common nerve-damaging complication of diabetes mellitus. Effective treatments are needed to alleviate and reverse diabetes-associated damage to the peripheral nerves. Curcumin is an effective neuroprotectant that plays a protective role in DPN promoted by Schwann cells (SCs) lesions. However, the potential molecular mechanism of curcumin remains unclear. Therefore, our aim is to study the detailed molecular mechanism of curcumin-mediated SCs repair in order to improve the efficacy of curcumin in the clinical treatment of DPN. First, candidate target genes of curcumin in rat SC line RSC96 cells stimulated by high glucose were identified by RNA sequencing and bioinformatic analyses. Enrichment analysis of Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) was carried out by Metascape, followed by 8 algorithms on Cytoscape to determine 4 hub genes, namly Hmox1, Pten, Vegfa and Myc. Next, gene set enrichment analysis (GSEA) and Pearson function showed that Hmox1 was significantly correlated with apoptosis. Subsequently, qRT-PCR, MTT assay, flow cytometry, caspase-3 activity detection and westernblot showed that curcumin treatment increased RSC96 cell viability, reduced cell apoptosis, increased Hmox1, Pten, Vegfa and Myc expression, and up-regulated Akt phosphorylation level under high glucose environment. Finally, molecular docking predicted the binding site of curcumin to Hmox1. These results suggest that curcumin can reduce the apoptosis of SCs induced by high glucose, and Hmox1 is a potential target for curcumin. Our findings provide new insights about the mechanism of action of curcumin on SC as a potential treatment in DPN.
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Affiliation(s)
- Ziqiang Lin
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, 510000, China; Department of Anesthesiology, The Third Affiliated Hospital of Southern Medical University, No. 183 Zhongshan Avenue West, Tianhe District, Guangzhou, Guangdong, 510000, China
| | - Suo Wang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, 510000, China
| | - Yu Cao
- Department of Anesthesiology, The Third Affiliated Hospital of Southern Medical University, No. 183 Zhongshan Avenue West, Tianhe District, Guangzhou, Guangdong, 510000, China
| | - Jialing Lin
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, 510000, China
| | - Ailing Sun
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, 510000, China
| | - Wei Huang
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, 510000, China
| | - Jun Zhou
- Department of Anesthesiology, The Third Affiliated Hospital of Southern Medical University, No. 183 Zhongshan Avenue West, Tianhe District, Guangzhou, Guangdong, 510000, China.
| | - Qingxiong Hong
- Department of Anesthesiology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, No. 111 Dade Road, Yuexiu District, Guangzhou, Guangdong, 510000, China.
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de Geus TJ, Franken G, Flinders B, Cuypers E, Joosten EAJ. The Effect of Spinal Cord Stimulation on Spinal Dorsal Horn Lipid Expression in Experimental Painful Diabetic Polyneuropathy: A Matrix-Assisted Laser Desorption/Ionization Time-of-Flight Mass Spectrometry Imaging Study. Neuromodulation 2024:S1094-7159(24)00710-4. [PMID: 39425735 DOI: 10.1016/j.neurom.2024.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2024] [Revised: 08/07/2024] [Accepted: 09/09/2024] [Indexed: 10/21/2024]
Abstract
OBJECTIVES Diabetes-induced peripheral nerve fiber damage can cause painful diabetic polyneuropathy (PDPN), induced by central sensitization through proinflammatory processes in the spinal dorsal horn. Disturbances in spinal dorsal horn lipid metabolism play a major role in proinflammatory regulation. Conventional (Con)-spinal cord stimulation (SCS) is an alternative treatment for pain relief in PDPN, whereas differential target multiplexed (DTM)-SCS could be more effective than Con-SCS, specifically targeting the spinal inflammatory response. We hypothesize that Con- and DTM-SCS differentially affect lipid metabolism in the spinal cord of PDPN animals. To study pain relief mechanisms, we analyzed lipid expression in the spinal dorsal horn using matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry imaging (MSI). MATERIAL AND METHODS Diabetes was induced through streptozotocin (STZ) injection in 28 rats, of which 12 developed PDPN. These and four nondiabetic animals (sham STZ) were implanted with a quadripolar lead and stimulated with Con-, DTM-, or Sham-SCS for 48 hours. Mechanical sensitivity was assessed using Von Frey filaments after 24 and 48 hours. After 48 hours of SCS, the spinal cord was collected, and lipids were analyzed using MALDI-TOF MSI. RESULTS STZ-induced hypersensitivity in the hind paws was reduced by Con- and DTM-SCS. PDPN induction decreased the expression of a glycosphingolipid in laminae 3 of the spinal dorsal horn. After 48 hours of Con- and DTM-SCS, expression levels of several lipids in the spinal dorsal horn decreased, including (HexCer 36:1;O, 40:1;O3), diacylglycerophosphocholines (PC 36:1, 38:6, 40:5), and diacylglycerophosphoserines (PS 36:4). CONCLUSIONS Both Con- and DTM-SCS provide pain relief and decrease spinal dorsal horn lipid expression of PDPN animals, highlighting the complex effects of SCS on the spinal cord physiology. STZ-induced PDPN has a limited effect on lipid expression in the spinal dorsal horn.
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Affiliation(s)
- Thomas J de Geus
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Research Institute of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands.
| | - Glenn Franken
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Research Institute of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
| | - Bryn Flinders
- Maastricht MultiModal Molecular Imaging Institute, Division of Mass Spectrometry Imaging, Maastricht University, Maastricht, The Netherlands
| | - Eva Cuypers
- Maastricht MultiModal Molecular Imaging Institute, Division of Mass Spectrometry Imaging, Maastricht University, Maastricht, The Netherlands
| | - Elbert A J Joosten
- Department of Anesthesiology and Pain Management, Maastricht University Medical Centre, Maastricht, The Netherlands; Research Institute of Mental Health and Neuroscience, Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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Braffett BH, El ghormli L, Albers JW, Feldman EL, Herman WH, Gubitosi-Klug RA, Martin CL, Orchard TJ, White NH, Lachin JM, Perkins BA, Pop-Busui R. Neuropathic Pain With and Without Diabetic Peripheral Neuropathy in Type 1 Diabetes. Diabetes Care 2024; 47:1559-1567. [PMID: 38300889 PMCID: PMC11362121 DOI: 10.2337/dc23-1749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/08/2023] [Indexed: 02/03/2024]
Abstract
OBJECTIVE Diabetic peripheral neuropathy (DPN) is common; however, the features and burden of neuropathic pain (NP) in type 1 diabetes (T1D) are poorly understood. We evaluated the incidence of first occurrence, annual prevalence, remission, and risk factors for NP during long-term follow-up of participants with T1D. RESEARCH DESIGN AND METHODS The Michigan Neuropathy Screening Instrument (MNSI) was administered annually (1994-2020) for 1,324 participants in the Epidemiology of Diabetes Interventions and Complications (EDIC) study. NP with clinical signs of DPN (NP DPN+) was defined according to self-reported NP plus an examination score >2, while NP without clinical signs of DPN (NP DPN-) was defined according to self-reported NP and an examination score ≤2. RESULTS At EDIC year 1, median age for participants was 36 years (interquartile range 30, 41), diabetes duration 13 years (10, 18), and HbA1c 7.9% (7.2, 8.9). At year 26 (median diabetes duration 39 years), cumulative incidence of NP was 57%, regardless of concomitant clinical signs of DPN (36% NP DPN+ vs. 46% NP DPN-). NP prevalence was 20% at 26 years (11% NP DPN+ and 9% NP DPN-), suggesting frequent remission. Annualized remission rates were similar regardless of pain medication use. In addition to HbA1c, female sex was associated with NP DPN-. CONCLUSIONS NP incidence in T1D was high and frequently occurred in the absence of clinical signs of neuropathy, as assessed with the MNSI. Pain remission was not explained by pain medication use. Effective clinical strategies for identification and management are needed.
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Affiliation(s)
| | - Laure El ghormli
- Biostatistics Center, The George Washington University, Rockville, MD
| | | | | | | | - Rose A. Gubitosi-Klug
- Case Western Reserve University, Rainbow Babies and Children’s Hospital, Cleveland, OH
| | | | | | - Neil H. White
- Washington University School of Medicine, Washington University in St. Louis, St. Louis, MO
| | - John M. Lachin
- Biostatistics Center, The George Washington University, Rockville, MD
| | - Bruce A. Perkins
- Division of Endocrinology, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
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Rozen SM, Wolfe GI, Vernino S, Raskin P, Hynan LS, Wyne K, Fulmer R, Pandian G, Sharma SK, Mohanty AJ, Sanchez CV, Hembd A, Gorman A. Effect of Lower Extremity Nerve Decompression in Patients With Painful Diabetic Peripheral Neuropathy: The Diabetic Neuropathy Nerve Decompression Randomized, Observation Group and Placebo Surgery-Controlled Clinical Trial. Ann Surg 2024; 280:35-45. [PMID: 38328975 DOI: 10.1097/sla.0000000000006228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
OBJECTIVE To evaluate the effect of nerve decompression on pain in patients with lower extremity painful diabetic peripheral neuropathy (DPN). BACKGROUND Currently, no treatment provides lasting relief for patients with DPN. The benefits of nerve decompression remain inconclusive. METHODS This double-blinded, observation and same-patient sham surgery-controlled randomized trial enrolled patients aged 18 to 80 years with lower extremity painful DPN who failed 1 year of medical treatment. Patients were randomized to nerve decompression or observation group (2:1). Decompression-group patients were further randomized and blinded to nerve decompression in either the right or left leg and sham surgery in the opposite leg. Pain (11-point Likert score) was compared between decompression and observation groups and between decompressed versus sham legs at 12 and 56 months. RESULTS Of 2987 screened patients, 78 were randomized. At 12 months, compared with controls (n=37), both the right-decompression group (n=22) and left-decompression group (n=18) reported lower pain (mean difference for both: -4.46; 95% CI: -6.34 to -2.58 and -6.48 to -2.45, respectively; P < 0.0001). Decompressed and sham legs equally improved. At 56 months, compared with controls (n=m 14), pain was lower in both the right-decompression group (n=20; mean difference: -7.65; 95% CI: -9.87 to -5.44; P < 0.0001) and left-decompression group (n=16; mean difference: -7.26; 95% CI: -9.60 to -4.91; P < 0.0001). The mean pain score was lower in decompressed versus sham legs (mean difference: 1.57 95% CI: 0.46 to 2.67; P =0.0002). CONCLUSIONS Although nerve decompression was associated with reduced pain, the benefit of surgical decompression needs further investigation as a placebo effect may be responsible for part or all of these effects.
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Affiliation(s)
- Shai M Rozen
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Gil I Wolfe
- Department of Neurology, School of Medicine and Biomedical Sciences, University at Buffalo Jacobs, Buffalo, NY
| | - Steven Vernino
- Department of Neurology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Philip Raskin
- Department of Internal Medicine, Division of Endocrinology, University of Texas Southwestern Medical Center, Dallas, TX
| | - Linda S Hynan
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Psychiatry, University of Texas Southwestern Medical Center, Dallas, TX
| | - Kathleen Wyne
- Department of Internal Medicine, Division of Endocrinology, Diabetes and Metabolism, The Ohio State University, Wexner Medical Center, Columbus, OH
| | - Rita Fulmer
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Geetha Pandian
- Department of Physical Medicine and Rehabilitation, University of Texas Southwestern Medical Center, Dallas, TX
| | - Shiv K Sharma
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX
| | - Ahneesh J Mohanty
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
- Department of Surgery, Section of Plastic and Reconstructive Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Cristina V Sanchez
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - Austin Hembd
- Department of Plastic and Reconstructive Surgery, University of Texas Southwestern Medical Center, Dallas, TX
| | - April Gorman
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, TX
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Sayed D, Deer TR, Hagedorn JM, Sayed A, D’Souza RS, Lam CM, Khatri N, Hussaini Z, Pritzlaff SG, Abdullah NM, Tieppo Francio V, Falowski SM, Ibrahim YM, Malinowski MN, Budwany RR, Strand NH, Sochacki KM, Shah A, Dunn TM, Nasseri M, Lee DW, Kapural L, Bedder MD, Petersen EA, Amirdelfan K, Schatman ME, Grider JS. A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET. J Pain Res 2024; 17:1461-1501. [PMID: 38633823 PMCID: PMC11022879 DOI: 10.2147/jpr.s451006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 03/19/2024] [Indexed: 04/19/2024] Open
Abstract
Introduction Painful diabetic neuropathy (PDN) is a leading cause of pain and disability globally with a lack of consensus on the appropriate treatment of those suffering from this condition. Recent advancements in both pharmacotherapy and interventional approaches have broadened the treatment options for PDN. There exists a need for a comprehensive guideline for the safe and effective treatment of patients suffering from PDN. Objective The SWEET Guideline was developed to provide clinicians with the most comprehensive guideline for the safe and appropriate treatment of patients suffering from PDN. Methods The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations for PDN. A multidisciplinary group of international experts developed the SWEET guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus to identify and compile the evidence for diabetic neuropathy pain treatments (per section as listed in the manuscript) for the treatment of pain. Manuscripts from 2000-present were included in the search process. Results After a comprehensive review and analysis of the available evidence, the ASPN SWEET guideline was able to rate the literature and provide therapy grades for most available treatments for PDN utilizing the United States Preventive Services Task Force criteria. Conclusion The ASPN SWEET Guideline represents the most comprehensive review of the available treatments for PDN and their appropriate and safe utilization.
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Affiliation(s)
- Dawood Sayed
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Ray Deer
- Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Asim Sayed
- Podiatry/Surgery, Susan B. Allen Memorial Hospital, El Dorado, KS, USA
| | - Ryan S D’Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher M Lam
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Nasir Khatri
- Interventional Pain Medicine, Novant Spine Specialists, Charlotte, NC, USA
| | - Zohra Hussaini
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Scott G Pritzlaff
- Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA
| | | | - Vinicius Tieppo Francio
- Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | | | - Yussr M Ibrahim
- Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA
| | | | - Ryan R Budwany
- Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA
| | | | - Kamil M Sochacki
- Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA
| | - Anuj Shah
- Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, MI, USA
| | - Tyler M Dunn
- Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Morad Nasseri
- Interventional Pain Medicine / Neurology, Boomerang Healthcare, Walnut Creek, CA, USA
| | - David W Lee
- Pain Management Specialist, Fullerton Orthopedic, Fullerton, CA, USA
| | | | - Marshall David Bedder
- Chief of Pain Medicine Service, Augusta VAMC, Augusta, GA, USA
- Associate Professor and Director, Addiction Medicine Fellowship Program, Department Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA
| | - Erika A Petersen
- Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Kasra Amirdelfan
- Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health – Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Jay Samuel Grider
- Anesthesiology, Division of Pain Medicine, University of Kentucky College of Medicine, Lexington, KY, USA
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Gad H, Kalra S, Pinzon R, Garcia RAN, Yotsombut K, Coetzee A, Nafach J, Lim LL, Fletcher PE, Lim V, Malik RA. Earlier diagnosis of peripheral neuropathy in primary care: A call to action. J Peripher Nerv Syst 2024; 29:28-37. [PMID: 38268316 DOI: 10.1111/jns.12613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 01/26/2024]
Abstract
Peripheral neuropathy (PN) often remains undiagnosed (~80%). Earlier diagnosis of PN may reduce morbidity and enable earlier risk factor reduction to limit disease progression. Diabetic peripheral neuropathy (DPN) is the most common PN and the 10 g monofilament is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration. There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs) have busy clinics and lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN. Involving the patient in the screening process would not only reduce the time a physician requires to make a diagnosis but would also empower the patient. Following an expert meeting of diabetologists and neurologists from the Middle East, South East Asia and Latin America, a consensus was formulated to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis.
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Affiliation(s)
- Hoda Gad
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
| | - Sanjay Kalra
- Department of Endocrinology, Bharti Hospital, Karnal, India
| | - Rizaldy Pinzon
- Neurology Department of the Bethesda, General Hospital Yogyakarta, Yogyakarta, Indonesia
| | - Rey-An Nino Garcia
- College of Medicine, De LA Salle, Health Medical and Science Institute College of Medicine, Manila, Philippines
| | - Kitiyot Yotsombut
- Faculty of Pharmaceutical Sciences, Chulalongkorn University, Bangkok, Thailand
| | - Ankia Coetzee
- Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Jalal Nafach
- Dubai Diabetes Center, Dubai Academic Health Corporation, Dubai, UAE
| | - Lee-Ling Lim
- Department of Medicine, Diabetes Care Unit, University of Malaya, Kuala Lumpur, Malaysia
| | - Pablo E Fletcher
- Endocrinology Department, Medical School, University of Panama, Panama, Panama
| | - Vivien Lim
- Endocrinology Department, Gleneagles Hospital, Singapore, Singapore
| | - Rayaz A Malik
- Research Department, Weill Cornell Medicine-Qatar, Doha, Qatar
- Institute of Cardiovascular Medicine, University of Manchester, Manchester, UK
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Velázquez-Flores MÁ, Sánchez-Chávez G, Morales-Lázaro SL, Ruiz Esparza-Garrido R, Canizales-Ontiveros A, Salceda R. Streptozotocin-Induced Diabetic Rats Showed a Differential Glycine Receptor Expression in the Spinal Cord: A GlyR Role in Diabetic Neuropathy. Neurochem Res 2024; 49:684-691. [PMID: 38017313 PMCID: PMC10884118 DOI: 10.1007/s11064-023-04058-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 10/24/2023] [Accepted: 10/26/2023] [Indexed: 11/30/2023]
Abstract
In the spinal cord, attenuation of the inhibitory action of glycine is related to an increase in both inflammatory and diabetic neuropathic pain; however, the glycine receptor involvement in diabetic neuropathy has not been reported. We determined the expression of the glycine receptor subunits (α1-α3 and β) in streptozotocin-induced diabetic Long-Evans rats by qPCR and Western blot. The total mRNA and protein expression (whole spinal cord homogenate) of the α1, α3, and β subunits did not change during diabetes; however, the α2 subunit mRNA, but not the protein, was overexpressed 45 days after diabetes induction. By contrast, the synaptic expression of the α1 and α2 subunits decreased in all the studied stages of diabetes, but that of the α3 subunit increased on day 45 after diabetes induction. Intradermal capsaicin produced higher paw-licking behavior in the streptozotocin-induced diabetic rats than in the control animals. In addition, the nocifensive response was higher at 45 days than at 20 days. During diabetes, the expression of the glycine receptor was altered in the spinal cord, which strongly suggests its involvement in diabetic neuropathy.
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Affiliation(s)
- Miguel Ángel Velázquez-Flores
- Noncoding RNAs Laboratory, Unit of Medical Research on Human Genetics, Children's Hospital "Silvestre Frenk Freund", National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Gustavo Sánchez-Chávez
- División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Sara L Morales-Lázaro
- División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Ruth Ruiz Esparza-Garrido
- Unit of Medical Research on Human Genetics, Children's Hospital "Silvestre Frenk Freund", National Medical Center Century XXI, Mexican Institute of Social Security, Mexico City, Mexico
| | - Alejandro Canizales-Ontiveros
- División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico
| | - Rocío Salceda
- División de Neurociencias, Instituto de Fisiología Celular, Universidad Nacional Autónoma de México, Mexico City, Mexico.
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Zuidema X, de Galan B, Brouwer B, Cohen SP, Eldabe S, Argoff CE, Huygen F, Van Zundert J. 4. Painful diabetic polyneuropathy. Pain Pract 2024; 24:308-320. [PMID: 37859565 DOI: 10.1111/papr.13308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Abstract
INTRODUCTION 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. METHODS The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized. RESULTS 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. CONCLUSIONS The diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.
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Affiliation(s)
- Xander Zuidema
- 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
| | - Bastiaan de Galan
- Division of Endocrinology, Department of Internal Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
- Department of Internal Medicine, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Brigitte Brouwer
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Steven P Cohen
- Department of Anesthesiology, Pain Medicine Division, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Sam Eldabe
- Department of Pain Medicine and Anesthesiology, Durham University, Durham, UK
| | - Charles E Argoff
- Department of Neurology, New York University School of Medicine, and Pain Management Center, North Shore University Hospital, Manhasset, New York, USA
| | - Frank Huygen
- Department of Anesthesiology and Pain Management, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Anesthesiology and Pain Management, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jan Van Zundert
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, The Netherlands
- Department of Anesthesiology, Intensive Care, Emergency Medicine and Multidisciplinary Pain Center, Ziekenhuis Oost-Limburg, Belgium
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9
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Elafros MA, Callaghan BC. Diabetic Neuropathies. Continuum (Minneap Minn) 2023; 29:1401-1417. [PMID: 37851036 PMCID: PMC11088946 DOI: 10.1212/con.0000000000001291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2023]
Abstract
OBJECTIVE This article provides an up-to-date review of the diagnosis and management of the most common neuropathies that occur in patients with diabetes. LATEST DEVELOPMENTS The prevalence of diabetes continues to grow worldwide and, as a result, the burden of diabetic neuropathies is also increasing. Most diabetic neuropathies are caused by hyperglycemic effects on small and large fiber nerves, and glycemic control in individuals with type 1 diabetes reduces neuropathy prevalence. However, among people with type 2 diabetes, additional factors, particularly metabolic syndrome components, play a role and should be addressed. Although length-dependent distal symmetric polyneuropathy is the most common form of neuropathy, autonomic syndromes, particularly cardiovascular autonomic neuropathy, are associated with increased mortality, whereas lumbosacral radiculoplexus neuropathy and treatment-induced neuropathy cause substantial morbidity. Recent evidence-based guidelines have updated the recommended treatment options to manage pain associated with distal symmetric polyneuropathy of diabetes. ESSENTIAL POINTS Identifying and appropriately diagnosing the neuropathies of diabetes is key to preventing progression. Until better disease-modifying therapies are identified, management remains focused on diabetes and metabolic risk factor control and pain management.
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10
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Li X, Kou S, Chen G, Zhao B, Xue J, Ding R, Zhao X, Ye M, Yang Y, Yue R, Li F. The relationship between vitamin D deficiency and diabetic foot ulcer: A meta-analysis. Int Wound J 2023; 20:3015-3022. [PMID: 37194326 PMCID: PMC10502267 DOI: 10.1111/iwj.14177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Revised: 03/21/2023] [Accepted: 03/22/2023] [Indexed: 05/18/2023] Open
Abstract
A meta-analysis investigation to measure the relationship between vitamin D deficiency (VDD) and diabetic foot ulcer (DFU). A comprehensive literature inspection till February 2023 was applied and 1765 interrelated investigations were reviewed. The 15 chosen investigations enclosed 2648 individuals with diabetes mellitus in the chosen investigations' starting point, 1413 of them were with DFUs, and 1235 were without DFUs. Odds ratio (OR) in addition to 95% confidence intervals (CIs) were used to compute the value of the relationship between VDD and DFU by the dichotomous and continuous approaches and a fixed or random model. Individuals with DFUs had significantly lower vitamin D levels (VDL) (MD, -7.14; 95% CI, -8.83 to -5.44, P < 0.001) compared to those without DFU individuals. Individuals with DFUs had a significantly higher number of VDD individuals (OR, 2.27; 95% CI, 1.63-3.16, P < 0.001) compared to those without DFU individuals. Individuals with DFU had significantly lower VDL and a significantly higher number of VDD individuals compared to those without DFU individuals. However, caused of the small sample sizes of several chosen investigations for this meta-analysis, care must be exercised when dealing with its values.
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Affiliation(s)
- Xin Li
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Shaojie Kou
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Guo Chen
- Department of Infectious DiseasesHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Bingjie Zhao
- Department of HaematologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Jingdong Xue
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Rui Ding
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Xiaoyan Zhao
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Miaoqing Ye
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Yueqing Yang
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
| | - Rensong Yue
- Department of EndocrinologyHospital of Chengdu University of Traditional Chinese MedicineChengduChina
| | - Fenping Li
- Department of Liver DiseaseShaanxi Provincial Hospital of Traditional Chinese MedicineXi'anChina
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11
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Doneddu PE, Pensato U, Iorfida A, Alberti C, Nobile-Orazio E, Fabbri A, Voza A. Neuropathic Pain in the Emergency Setting: Diagnosis and Management. J Clin Med 2023; 12:6028. [PMID: 37762968 PMCID: PMC10531819 DOI: 10.3390/jcm12186028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 09/04/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Neuropathic pain, traditionally considered a chronic condition, is increasingly encountered in the emergency department (ED), accounting for approximately 20% of patients presenting with pain. Understanding the physiology and key clinical presentations of neuropathic pain is crucial for ED physicians to provide optimal treatment. While diagnosing neuropathic pain can be challenging, emphasis should be placed on obtaining a comprehensive medical history and conducting a thorough clinical examination. Patients often describe neuropathic pain as a burning or shock-like sensation, leading them to seek care in the ED after ineffective relief from common analgesics such as paracetamol and NSAIDs. Collaboration between emergency medicine specialists, neurologists, and pain management experts can contribute to the development of evidence-based guidelines specifically tailored for the emergency department setting. This article provides a concise overview of the common clinical manifestations of neuropathic pain that may prompt patients to seek emergency care.
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Affiliation(s)
- Pietro Emiliano Doneddu
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
| | - Umberto Pensato
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Neurology and Stroke Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Alessandra Iorfida
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Emergency Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Claudia Alberti
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
| | - Eduardo Nobile-Orazio
- Neuromuscular and Neuroimmunology Unit, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
- Department of Medical Biotechnology and Translational Medicine, Milan University, 20133 Milano, MI, Italy
| | - Andrea Fabbri
- Emergency Department AUSL Romagna, Presidio Ospedaliero Morgagni-Pierantoni, 47121 Forlì, FC, Italy
| | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, MI, Italy
- Emergency Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, MI, Italy
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12
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Zuidema X, van Daal E, van Geel I, de Geus TJ, van Kuijk SMJ, de Galan BE, de Meij N, Van Zundert J. Long-Term Evaluation of Spinal Cord Stimulation in Patients With Painful Diabetic Polyneuropathy: An Eight-to-Ten-Year Prospective Cohort Study. Neuromodulation 2023; 26:1074-1080. [PMID: 36587999 DOI: 10.1016/j.neurom.2022.12.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 11/05/2022] [Accepted: 12/03/2022] [Indexed: 01/01/2023]
Abstract
OBJECTIVE This study aimed to evaluate the long-term effects of spinal cord stimulation (SCS) in patients with painful diabetic polyneuropathy (PDPN). MATERIALS AND METHODS This prospective cohort study was the eight-to-ten-year follow-up of a previously performed pilot and randomized controlled trial on the effects of SCS in PDPN, initiated by the multidisciplinary pain center of Maastricht University Medical Center+. The study population consisted of a subgroup of patients who still used SCS treatment ≥ eight years after implantation (n = 19). Pain intensity scores (numeric rating scale [NRS]) during the day and night and data on secondary outcomes (ie, quality of life, depression, sleep quality) were reported during yearly follow-up consultations. Long-term efficacy of SCS was analyzed by comparing the most recently obtained data eight to ten years after implantation with those obtained at baseline. RESULTS Pain intensity, day and night, was significantly (p < 0.01) reduced by 2.3 (NRS 6.6-4.3) and 2.2 (NRS 6.8-4.6) points, respectively, when comparing the long-term data with baseline. Moreover, for > 50% of patients, the pain reduction was > 30%, which is considered clinically meaningful. No differences were found regarding the secondary outcomes. CONCLUSION This eight-to-ten-year follow-up study indicates that SCS can remain an effective treatment in the long term to reduce pain intensity in a subcohort of patients with PDPN who still had an SCS device implanted after eight years.
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Affiliation(s)
- Xander Zuidema
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Anesthesiology and Pain Management, Diakonessenhuis Utrecht/Zeist/Doorn, Utrecht, The Netherlands
| | - Elke van Daal
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Iris van Geel
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Thomas J de Geus
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Bastiaan E de Galan
- Department of Internal Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands; Department of Internal Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Nelleke de Meij
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.
| | - Jan Van Zundert
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands; Department of Anesthesiology, Critical Care and Multidisciplinary Pain Center, Ziekenhuis Oost Limburg, Genk, Belgium
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13
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Lechner S, Steimbach RR, Wang L, Deline ML, Chang YC, Fromme T, Klingenspor M, Matthias P, Miller AK, Médard G, Kuster B. Chemoproteomic target deconvolution reveals Histone Deacetylases as targets of (R)-lipoic acid. Nat Commun 2023; 14:3548. [PMID: 37322067 PMCID: PMC10272112 DOI: 10.1038/s41467-023-39151-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
Lipoic acid is an essential enzyme cofactor in central metabolic pathways. Due to its claimed antioxidant properties, racemic (R/S)-lipoic acid is used as a food supplement but is also investigated as a pharmaceutical in over 180 clinical trials covering a broad range of diseases. Moreover, (R/S)-lipoic acid is an approved drug for the treatment of diabetic neuropathy. However, its mechanism of action remains elusive. Here, we performed chemoproteomics-aided target deconvolution of lipoic acid and its active close analog lipoamide. We find that histone deacetylases HDAC1, HDAC2, HDAC3, HDAC6, HDAC8, and HDAC10 are molecular targets of the reduced form of lipoic acid and lipoamide. Importantly, only the naturally occurring (R)-enantiomer inhibits HDACs at physiologically relevant concentrations and leads to hyperacetylation of HDAC substrates. The inhibition of HDACs by (R)-lipoic acid and lipoamide explain why both compounds prevent stress granule formation in cells and may also provide a molecular rationale for many other phenotypic effects elicited by lipoic acid.
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Affiliation(s)
- Severin Lechner
- Chair of Proteomics and Bioanalytics, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Raphael R Steimbach
- Cancer Drug Development, German Cancer Research Center (DKFZ), Heidelberg, Germany
- Biosciences Faculty, Heidelberg University, Heidelberg, Germany
| | - Longlong Wang
- Friedrich Miescher Institute for Biomedical Research, 4058, Basel, Switzerland
- Faculty of Sciences, University of Basel, 4031, Basel, Switzerland
| | - Marshall L Deline
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Yun-Chien Chang
- Chair of Proteomics and Bioanalytics, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Tobias Fromme
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
- EKFZ - Else Kröner Fresenius Center for Nutritional Medicine, Technical University of Munich, Freising, Germany
| | - Martin Klingenspor
- Chair of Molecular Nutritional Medicine, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
- EKFZ - Else Kröner Fresenius Center for Nutritional Medicine, Technical University of Munich, Freising, Germany
- ZIEL Institute for Food & Health, Technical University of Munich, Freising, Germany
| | - Patrick Matthias
- Friedrich Miescher Institute for Biomedical Research, 4058, Basel, Switzerland
- Faculty of Sciences, University of Basel, 4031, Basel, Switzerland
| | - Aubry K Miller
- Cancer Drug Development, German Cancer Research Center (DKFZ), Heidelberg, Germany
- German Cancer Consortium (DKTK), Heidelberg, Germany
| | - Guillaume Médard
- Chair of Proteomics and Bioanalytics, TUM School of Life Sciences, Technical University of Munich, Freising, Germany
| | - Bernhard Kuster
- Chair of Proteomics and Bioanalytics, TUM School of Life Sciences, Technical University of Munich, Freising, Germany.
- German Cancer Consortium (DKTK), Heidelberg, Germany.
- Bavarian Center for Biomolecular Mass Spectrometry (BayBioMS), Technical University of Munich, Freising, Germany.
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14
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Abdalla MMI, Mohanraj J, Somanath SD. Adiponectin as a therapeutic target for diabetic foot ulcer. World J Diabetes 2023; 14:758-782. [PMID: 37383591 PMCID: PMC10294063 DOI: 10.4239/wjd.v14.i6.758] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/25/2023] [Accepted: 04/24/2023] [Indexed: 06/14/2023] Open
Abstract
The global burden of diabetic foot ulcers (DFUs) is a significant public health concern, affecting millions of people worldwide. These wounds cause considerable suffering and have a high economic cost. Therefore, there is a need for effective strategies to prevent and treat DFUs. One promising therapeutic approach is the use of adiponectin, a hormone primarily produced and secreted by adipose tissue. Adiponectin has demonstrated anti-inflammatory and anti-atherogenic properties, and researchers have suggested its potential therapeutic applications in the treatment of DFUs. Studies have indicated that adiponectin can inhibit the production of pro-inflammatory cytokines, increase the production of vascular endothelial growth factor, a key mediator of angiogenesis, and inhibit the activation of the intrinsic apoptotic pathway. Additionally, adiponectin has been found to possess antioxidant properties and impact glucose metabolism, the immune system, extracellular matrix remodeling, and nerve function. The objective of this review is to summarize the current state of research on the potential role of adiponectin in the treatment of DFUs and to identify areas where further research is needed in order to fully understand the effects of adiponectin on DFUs and to establish its safety and efficacy as a treatment for DFUs in the clinical setting. This will provide a deeper understanding of the underlying mechanisms of DFUs that can aid in the development of new and more effective treatment strategies.
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Affiliation(s)
- Mona Mohamed Ibrahim Abdalla
- Department of Physiology, Human Biology Division, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Jaiprakash Mohanraj
- Department of Biochemistry, Human Biology Division, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
| | - Sushela Devi Somanath
- Department of Microbiology, School of Medicine, International Medical University, Kuala Lumpur 57000, Malaysia
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15
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Preston FG, Riley DR, Azmi S, Alam U. Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management. Diabetes Metab Syndr Obes 2023; 16:1595-1612. [PMID: 37288250 PMCID: PMC10243347 DOI: 10.2147/dmso.s370050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
Painful diabetic peripheral neuropathy (PDPN) is present in nearly a quarter of people with diabetes. It is estimated to affect over 100 million people worldwide. PDPN is associated with impaired daily functioning, depression, sleep disturbance, financial instability, and a decreased quality of life. Despite its high prevalence and significant health burden, it remains an underdiagnosed and undertreated condition. PDPN is a complex pain phenomenon with the experience of pain associated with and exacerbated by poor sleep and low mood. A holistic approach to patient-centred care alongside the pharmacological therapy is required to maximise benefit. A key treatment challenge is managing patient expectation, as a good outcome from treatment is defined as a reduction in pain of 30-50%, with a complete pain-free outcome being rare. The future for the treatment of PDPN holds promise, despite a 20-year void in the licensing of new analgesic agents for neuropathic pain. There are over 50 new molecular entities reaching clinical development and several demonstrating benefit in early-stage clinical trials. We review the current approaches to its diagnosis, the tools, and questionnaires available to clinicians, international guidance on PDPN management, and existing pharmacological and non-pharmacological treatment options. We synthesise evidence and the guidance from the American Association of Clinical Endocrinology, American Academy of Neurology, American Diabetes Association, Diabetes Canada, German Diabetes Association, and the International Diabetes Federation into a practical guide to the treatment of PDPN and highlight the need for future research into mechanistic-based treatments in order to prioritise the development of personalised medicine.
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Affiliation(s)
- Frank G Preston
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK
| | - David R Riley
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester and Manchester Diabetes Centre, Manchester Foundation Trust, Manchester, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
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16
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Syed O, Jancic P, Knezevic NN. A Review of Recent Pharmacological Advances in the Management of Diabetes-Associated Peripheral Neuropathy. Pharmaceuticals (Basel) 2023; 16:801. [PMID: 37375749 DOI: 10.3390/ph16060801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/29/2023] Open
Abstract
Diabetic peripheral neuropathy is a common complication of longstanding diabetes mellitus. These neuropathies can present in various forms, and with the increasing prevalence of diabetes mellitus, a subsequent increase in peripheral neuropathy cases has been noted. Peripheral neuropathy has a significant societal and economic burden, with patients requiring concomitant medication and often experiencing a decline in their quality of life. There is currently a wide variety of pharmacological interventions, including serotonin norepinephrine reuptake inhibitors, gapentanoids, sodium channel blockers, and tricyclic antidepressants. These medications will be discussed, as well as their respective efficacies. Recent advances in the treatment of diabetes mellitus with incretin system-modulating drugs, specifically glucagon-like peptide-1 agonists, have been promising, and their potential implication in the treatment of peripheral diabetic neuropathy is discussed in this review.
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Affiliation(s)
- Osman Syed
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA
- Chicago College of Osteopathic Medicine, Midwestern University, Downers Grove, IL 60515, USA
| | - Predrag Jancic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA
| | - Nebojsa Nick Knezevic
- Advocate Illinois Masonic Medical Center, Department of Anesthesiology, Chicago, IL 60657, USA
- Department of Anesthesiology, University of Illinois, Chicago, IL 60612, USA
- Department of Surgery, University of Illinois, Chicago, IL 60612, USA
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17
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Tesfaye S, Brill S, Eerdekens M, Labrador MM, Petersen G, de Rooij Peek A, Reta A, Ryan D, Schaper N, Tölle T, Truini A, Ziegler D. Diagnosis, management and impact of painful diabetic peripheral neuropathy: A patient survey in four European countries. J Diabetes Complications 2023; 37:108417. [PMID: 36905720 DOI: 10.1016/j.jdiacomp.2023.108417] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 01/16/2023] [Accepted: 02/01/2023] [Indexed: 02/12/2023]
Abstract
AIMS The aim of this study was to assess patient perspectives and experiences of the impact of neuropathic pain, painful diabetic neuropathy (pDPN) diagnosis and treatment, and the patient-healthcare professional (HCP) relationship. METHODS We conducted a quantitative online survey in Germany, the Netherlands, Spain, and the UK among adults with diabetes who responded "yes" to at least four of ten questions of in the Douleur Neuropathique en 4 Questions (DN4) questionnaire. RESULTS Of 3626 respondents, 576 met the eligibility criteria. Daily pain was rated as moderate or severe by 79 % of respondents. Most participants reported a negative impact of their pain on sleep (74 %), mood (71 %), exercise (69 %), concentration (64 %) and daily activities (62 %), and 75 % of those in employment had missed work because of their pain in the past year. Overall, 22 % of respondents avoided discussing pain with their HCP, 50 % had not received formal pDPN diagnosis, and 56 % had not used prescribed pain medications. Although two-thirds (67 %) of respondents reported feeling satisfied or very satisfied with treatment, 82 % of these patients still experienced daily moderate or severe pain. CONCLUSIONS Neuropathic pain in people with diabetes affects daily life and remains underdiagnosed and undertreated in clinical practice.
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Affiliation(s)
| | - Silviu Brill
- Institute of Pain Medicine, Tel Aviv Medical Center, Israel
| | | | | | | | | | | | | | - Nicolaas Schaper
- Division of Endocrinology, Maastricht University Hospital, Netherlands
| | - Thomas Tölle
- Neurologische Klinik und Poliklinik der TU, München, Germany
| | - Andrea Truini
- Department of Human Neuroscience, Università Sapienza Rome, Italy
| | - Dan Ziegler
- Institute for Clinical Diabetology, German Diabetes Center at Heinrich Heine University, Düsseldorf, Germany
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18
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Li C, Wang W, Ji Q, Ran X, Kuang H, Yu X, Fang H, Yang J, Liu J, Xue Y, Feng B, Lei M, Zhu D. Prevalence of painful diabetic peripheral neuropathy in type 2 diabetes mellitus and diabetic peripheral neuropathy: A nationwide cross-sectional study in mainland China. Diabetes Res Clin Pract 2023; 198:110602. [PMID: 36871876 DOI: 10.1016/j.diabres.2023.110602] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 01/31/2023] [Accepted: 02/28/2023] [Indexed: 03/06/2023]
Abstract
AIM The study aimed to assess the prevalence and risk factors of painful diabetic peripheral neuropathy (PDPN) in patients with type 2 diabetes mellitus (T2DM) and diabetic peripheral neuropathy (DPN) in mainland China. METHODS This nationwide cross-sectional study enrolled T2DM patients with DPN from 25 provinces in China between July 2017 and December 2017. The prevalence, characteristics, and risk factors of PDPN were analyzed. RESULTS Among 25,710 patients with T2DM and DPN, 14,699 (57.2%) had PDPN. The median age was 63 years old. Age over 40 years old, education level, hypertension, myocardial infarction, duration of diabetes of over five years, diabetic retinopathy and nephropathy, moderate total cholesterol, moderate and higher low-density lipoprotein (LDL) increased uric acid (UA) and decreased estimated glomerular filtration rate (eGFR) were independently associated with PDPN (all P < 0.05). Compared with low levels of C-peptide, moderate levels were independently associated with a higher risk of PDPN, while high levels were associated with a lower risk (all P < 0.001). CONCLUSIONS In mainland China, more than half of the patients with DPN have neuropathic pain. Patients with older age, lower education level, longer duration of diabetes, lower LDL, increased UA, decreased eGFR, and comorbidities had an increased risk of PDPN.
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Affiliation(s)
- Chenxi Li
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Weimin Wang
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China
| | - Qiuhe Ji
- Xijing Hospital of PLA Air Force Medical University, Xi'an, Shanxi Province, China
| | - Xingwu Ran
- Department of Endocrinology, West China Hospital of Sichuan University, Chengdu, Sichuan Province, China
| | - Hongyu Kuang
- Department of Endocrinology, The First Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, China
| | - Xuefeng Yu
- Tongji Hospital Affiliated to Tongji Medical College of Huazhong University of Science & Technology, Wuhan, Hubei Province, China
| | - Hui Fang
- Tangshan Gongren Hospital, TangShan, Hebei Province, China
| | - Jing Yang
- Department of Endocrinology, The First Hospital of Shanxi Medical University, Taiyuan, Shanxi Province, China
| | - Jing Liu
- Gansu Provincial Hospital, Lanzhou, Gansu Province, China
| | - Yaoming Xue
- Department of Endocrinology and Metabolism, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Bo Feng
- Department of Endocrinology, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Minxiang Lei
- Department of Endocrinology, Xiangya Hospital of Central South University, Changsha, Hunan Province, China
| | - Dalong Zhu
- Department of Endocrinology, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, Jiangsu Province, China; Branch of National Clinical Research Centre for Metabolic Diseases, Nanjing, China.
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19
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de Geus TJ, Franken G, Joosten EA. Conventional, high frequency and differential targeted multiplexed spinal cord stimulation in experimental painful diabetic peripheral neuropathy: Pain behavior and role of the central inflammatory balance. Mol Pain 2023; 19:17448069231193368. [PMID: 37488684 PMCID: PMC10504849 DOI: 10.1177/17448069231193368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/26/2023] Open
Abstract
Spinal cord stimulation (SCS) is a last resort treatment for pain relief in painful diabetic peripheral neuropathy (PDPN) patients. However, the effectivity of SCS in PDPN is limited. New SCS paradigms such as high frequency (HF) and differential target multiplexed (DTM) might improve responder rates and efficacy of SCS-induced analgesia in PDPN patients, and are suggested to modulate the inflammatory balance and glial response in the spinal dorsal horn. The aim of this study was to research the effects of Con-, HF- and DTM-SCS on pain behavior and the spinal inflammatory balance in an animal model of PDPN. Streptozotocin-induced PDPN animals were stimulated for 48 hours with either Con-SCS (50Hz), HF-SCS (1200Hz) or DTM-SCS (combination of Con- and HF-SCS). Mechanical hypersensitivity was assessed using Von Frey (VF) test and the motivational aspects of pain were assessed using the mechanical conflict avoidance system (MCAS). The inflammatory balance and glial response were analyzed in the dorsal spinal cord based on RNA expression of pro- and anti-inflammatory cytokines (Tnf-α, Il-1ß, Il-4, Il-10), a microglia marker (Itgam), an astrocyte marker (Gfap), a T-cell marker (Cd3d), microglia proliferation markers (Irf8, Adgre1) and P2X4, p13-MAPK, BDNF signaling markers (P2x4, Mapk14, Bdnf). The results show that Con-, HF-, and DTM-SCS significantly decreased hypersensitivity after 48 hours of stimulation compared to Sham-SCS in PDPN animals, but at the same time did not affect escape latency in the MCAS. At the molecular level, Con-SCS resulted in a significant increase in spinal pro-inflammatory cytokine Tnf-α after 48 hours compared to DTM-SCS and Sham-SCS. In summary, Con-SCS showed a shift of the inflammatory balance towards a pro-inflammatory state whilst HF- and DTM-SCS shifted the balance towards an anti-inflammatory state. These findings suggest that the underlying mechanism of Con-SCS induced pain relief in PDPN differs from that induced by HF- and DTM-SCS.
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Affiliation(s)
- Thomas J. de Geus
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Glenn Franken
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Elbert A Joosten
- Department of Translational Neuroscience, School of Mental Health and Neuroscience, Maastricht University, Maastricht, Netherlands
- Department of Anesthesiology and Pain Medicine, Maastricht University Medical Centre, Maastricht, Netherlands
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20
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Lin J, Mo X, Yang Y, Tang C, Chen J. Association between vitamin D deficiency and diabetic foot ulcer wound in diabetic subjects: A meta-analysis. Int Wound J 2023; 20:55-62. [PMID: 35567425 PMCID: PMC9797924 DOI: 10.1111/iwj.13836] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Revised: 04/21/2022] [Accepted: 04/24/2022] [Indexed: 01/07/2023] Open
Abstract
A meta-analysis was performed to evaluate the association between vitamin D deficiency and diabetic foot ulcer wounds in diabetic subjects. A systematic literature search up to March 2022 incorporated 7586 subjects with diabetes mellitus at the beginning of the study; 1565 were using diabetic subjects with foot ulcer wounds, and 6021 were non-ulcerated diabetic subjects. Statistical tools like the dichotomous and contentious method were used within a random or fixed-influence model to establish the odds ratio (OR) and mean difference (MD) with 95% confidence intervals (CIs) to evaluate the influence of vitamin D deficiency in managing diabetic foot ulcer wound. Diabetic subjects with foot ulcer wounds had significantly lower vitamin D levels (MD, -6.48; 95% CI, -10.84 to -2.11, P < .004), higher prevalence of vitamin D deficiency (<50 nmoL/L) (OR, 1.82; 95% CI, 1.32-2.52, P < .001), and higher prevalence of severe vitamin D deficiency (OR, 2.53; 95% CI, 1.65-3.89, P < .001) compared with non-ulcerated diabetic subjects. Diabetic subjects with foot ulcer wounds had significantly lower vitamin D levels, higher prevalence of vitamin D deficiency, and higher prevalence of severe vitamin D deficiency compared with non-ulcerated diabetic subjects. Further studies are required to validate these findings.
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Affiliation(s)
- Juan Lin
- Nursing School of Shaoyang UniversityHunanChina
| | - Xinxin Mo
- Nursing School of Shaoyang UniversityHunanChina
| | - Yejun Yang
- Department of PediatricShaoyang Central HospitalHunanChina
| | - Chao Tang
- Nursing School of Shaoyang UniversityHunanChina
| | - Jia Chen
- Xiangya School of Nursing School of Central South UniversityHunanChina
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21
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Elafros MA, Andersen H, Bennett DL, Savelieff MG, Viswanathan V, Callaghan BC, Feldman EL. Towards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments. Lancet Neurol 2022; 21:922-936. [PMID: 36115364 PMCID: PMC10112836 DOI: 10.1016/s1474-4422(22)00188-0] [Citation(s) in RCA: 76] [Impact Index Per Article: 38.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 03/15/2022] [Accepted: 04/29/2022] [Indexed: 12/24/2022]
Abstract
Diabetic peripheral neuropathy (DPN) occurs in up to half of individuals with type 1 or type 2 diabetes. DPN results from the distal-to-proximal loss of peripheral nerve function, leading to physical disability and sometimes pain, with the consequent lowering of quality of life. Early diagnosis improves clinical outcomes, but many patients still develop neuropathy. Hyperglycaemia is a risk factor and glycaemic control prevents DPN development in type 1 diabetes. However, glycaemic control has modest or no benefit in individuals with type 2 diabetes, probably because they usually have comorbidities. Among them, the metabolic syndrome is a major risk factor for DPN. The pathophysiology of DPN is complex, but mechanisms converge on a unifying theme of bioenergetic failure in the peripheral nerves due to their unique anatomy. Current clinical management focuses on controlling diabetes, the metabolic syndrome, and pain, but remains suboptimal for most patients. Thus, research is ongoing to improve early diagnosis and prognosis, to identify molecular mechanisms that could lead to therapeutic targets, and to investigate lifestyle interventions to improve clinical outcomes.
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Affiliation(s)
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, University of Oxford, Oxford, UK
| | | | - Vijay Viswanathan
- MV Hospital for Diabetes and Prof M Viswanathan Diabetes Research Centre, Royapuram, Chennai, India
| | | | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA.
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22
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Tatikola SP, Natarajan V, Desai VK, Asirvatham AR, Rajsekhar H. Effect of various exercise protocols on neuropathic pain in individuals with type 2 diabetes with peripheral neuropathy: A systematic review and meta-analysis. Diabetes Metab Syndr 2022; 16:102603. [PMID: 36049390 DOI: 10.1016/j.dsx.2022.102603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 08/11/2022] [Accepted: 08/14/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Diabetic neuropathy is considered as the most common and alarming microvascular complication of diabetes worldwide. Despite the recent major advances, there remains a dearth in literature on effective treatment options that appropriately target the natural history of painful diabetic neuropathy. AIMS To review various exercise programs for neuropathic pain in type 2 diabetes individuals with diabetic peripheral neuropathy. METHODS An extensive literature search was performed in Scopus, Web of Science, PubMed, Science direct and ProQuest. The inclusion criteria were exercise program for neuropathic pain in type 2 diabetes individuals. Animal studies, chemotherapy, electrotherapy, yoga, behavioural and psychological approaches, and other medical interventions were excluded. A systematic strategy to conduct a review was planned, to search, screen articles and extract data by two reviewers independently. RESULTS Nine out of total 5342 screened articles were identified as relevant for the comprehensive review. The studies included exercise protocols for neuropathic pain in people with type 2 diabetes mellitus. Overall, studies were of low to moderate quality evidence. The findings of this review suggested incorporating exercise program for painful diabetic neuropathy. Exercise intervention is effective in reducing the Michigan neuropathy score (Standardized Mean Difference -2.92, 95% Confidence Interval -4.49 to -1.24; participants = 114; studies = 3; I2 = 88%) Conclusion: A structured exercise prescription need to be designed exclusively for neuropathic pain in population with type 2 diabetes to improve quality of life. However, there is a further need to explore exercise training to strengthen evidence using large clinical trials.
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Affiliation(s)
- Sripada Pallavi Tatikola
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India.
| | - Venkatesh Natarajan
- Faculty of Physiotherapy, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Venkata Krishnaveni Desai
- Department of Biochemistry, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
| | - Adlyne Reena Asirvatham
- Department of Endocrinology, Sri Ramachandra Institute of Higher Education and Research, Chennai, Tamil Nadu, India
| | - Hannah Rajsekhar
- Apollo College of Physiotherapy, Apollo Institute of Medical Sciences and Research, Hyderabad, Telangana, India
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23
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Pirvulescu I, Biskis A, Candido KD, Knezevic NN. Overcoming clinical challenges of refractory neuropathic pain. Expert Rev Neurother 2022; 22:595-622. [PMID: 35866187 DOI: 10.1080/14737175.2022.2105206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : Refractory neuropathic pain (ReNP), and its definition, is widely disputed amongst clinicians due in part to unclear categorical diagnosing guidelines, overall time duration of neuropathic pain, and the exhaustiveness of treatment options. Usually ReNP is defined as chronic, intractable, and unresponsive neuropathic pain that have otherwise been untreatable. AREAS COVERED : In this narrative review, we discuss and summarize the effectiveness of prospective ReNP research conducted over the past 10 years. This research looks at pharmacological and interventional therapies in clinical trial settings. The pharmacological therapies discussed include the use of adjuvant treatments to improve the safety and efficacy of conventional approaches. Different modalities of administration, such as injection therapy and intrathecal drug delivery systems, provide targeted drug delivery. Interventional therapies such as neuromodulation, pulse radiofrequency, and nerve lesioning are more invasive, however, they are increasingly utilized in the field, as reflected in ongoing clinical trials. EXPERT OPINION : Based on the current data from RCTs and systematic reviews, it is clear that single drug therapy cannot be effective and has significant limitations. Transitioning to interventional modalities that showed more promising results sooner rather than later may be even more cost-efficient than attempting different conservative treatments with a high failure rate.
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Affiliation(s)
- Iulia Pirvulescu
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA
| | - Alexandras Biskis
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.,Advocate Aurora Research Institute, Chicago, IL, USA.,College of Aviation, Science and Technology, Lewis University, Romeoville, IL, USA
| | - Kenneth D Candido
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL, USA.,Department of Surgery, University of Illinois, Chicago, IL, USA
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL, USA.,Department of Anesthesiology, University of Illinois, Chicago, IL, USA.,Department of Surgery, University of Illinois, Chicago, IL, USA
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24
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Gnasso R, Corrado B, Iommazzo I, Migliore F, Magliulo G, Giardulli B, Ruosi C. Assessment, pharmacological therapy and rehabilitation management of musculoskeletal pain in children with mucopolysaccharidoses: a scoping review. Orphanet J Rare Dis 2022; 17:255. [PMID: 35804400 PMCID: PMC9264657 DOI: 10.1186/s13023-022-02402-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 06/26/2022] [Indexed: 11/10/2022] Open
Abstract
Background Pain of musculoskeletal origin is very common in young patients affected by Mucopolysaccharidoses. This scoping review evaluates the evidence for assessment, pharmacological treatment and rehabilitation management for musculoskeletal pain of the latter. Methods A Medline search through PubMed has been performed for studies published in English at least for the past twenty years. Two investigators independently reviewed all search results and extracted those that met the inclusion criteria. Results 29 studies have been selected and analysed in depth, of which 10 related to pain assessment, 11 concerned pharmacological approach, and 8 reported rehabilitation approaches. Conclusion Few data are available in literature concerning the classification and management of pain in children with Mucopolysaccharidoses. Notwithstanding, pain evaluation methods are effectively used to classify pain intensity, according to the age group and communication abilities of young Mucopolysaccharidoses patients. The review emphasizes that drug therapies have a palliative purpose, while rehabilitation reduces musculoskeletal pain and can provide a therapeutic effect on disabilities.
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Affiliation(s)
- R Gnasso
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy.
| | - B Corrado
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - I Iommazzo
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - F Migliore
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - G Magliulo
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - B Giardulli
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
| | - C Ruosi
- Physical Medicine and Rehabilitation, Department of Public Health, University Federico II of Naples, Via S. Pansini, 5, 80131, Naples, Italy
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25
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Painful Diabetic Neuropathy as a Cause for Refractory Ear Pain in Type 2 Diabetic Patients. Otol Neurotol 2022; 43:e688-e693. [PMID: 35283467 DOI: 10.1097/mao.0000000000003526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To assess painful diabetic neuropathy (PDN) as a cause for refractory ear pain in type 2 diabetics. DESIGN An observational prospective case series study. SETTING Otolaryngology departments of tertiary referral hospitals from November 2019 to January 2021. PATIENTS Sixty-eight patients with type 2 diabetes with refractory ear pain of more than 1-month duration not responding to the routine analgesics. INTERVENTION Diagnostic intervention. MAIN OUTCOME MEASURE The primary outcome measure was the prevalence of painful diabetic neuropathy among different causes of ear pain in the study sample of type II diabetics with refractory ear pain with an assessment of the response of these cases to routine neuropathic pain treatment with pregabalin. RESULTS Fifteen out of 68 (22.1%) were diagnosed as having painful diabetic neuropathy based on the "Douleur Neuropathique en 4 Questions" (DN4) questionnaire with its mean value being 6.47±1.19. There was a highly significant improvement of the 10 items of painful diabetic neuropathy scales after 1 month of treatment ( p < 0.001 for all). There was a significant positive correlation between the Hemoglobin A1c level and duration of diabetes at one hand and intensity of pain derived from the painful diabetic neuropathy scale at the other hand ( p = 0.0002, and p = 0.032 respectively). CONCLUSION Painful diabetic neuropathy showed a potential correlation with refractory ear pain in type II diabetic patients with significant improvement after painful diabetic neuropathy treatment. Further studies are needed to confirm these findings.
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26
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Fang XX, Wang H, Song HL, Wang J, Zhang ZJ. Neuroinflammation Involved in Diabetes-Related Pain and Itch. Front Pharmacol 2022; 13:921612. [PMID: 35795572 PMCID: PMC9251344 DOI: 10.3389/fphar.2022.921612] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Accepted: 05/12/2022] [Indexed: 12/25/2022] Open
Abstract
Diabetes mellitus (DM) is a global epidemic with increasing incidence, which results in diverse complications, seriously affects the patient quality of life, and brings huge economic burdens to society. Diabetic neuropathy is the most common chronic complication of DM, resulting in neuropathic pain and chronic itch. The precise mechanisms of diabetic neuropathy have not been fully clarified, hindering the exploration of novel therapies for diabetic neuropathy and its terrible symptoms such as diabetic pain and itch. Accumulating evidence suggests that neuroinflammation plays a critical role in the pathophysiologic process of neuropathic pain and chronic itch. Indeed, researchers have currently made significant progress in knowing the role of glial cells and the pro-inflammatory mediators produced from glial cells in the modulation of chronic pain and itch signal processing. Here, we provide an overview of the current understanding of neuroinflammation in contributing to the sensitization of the peripheral nervous system (PNS) and central nervous system (CNS). In addition, we also summarize the inflammation mechanisms that contribute to the pathogenesis of diabetic itch, including activation of glial cells, oxidative stress, and pro-inflammatory factors. Targeting excessive neuroinflammation may provide potential and effective therapies for the treatment of chronic neuropathic pain and itch in DM.
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Affiliation(s)
- Xiao-Xia Fang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
- Department of Medical Functional Laboratory, School of Medicine, Nantong University, Nantong, China
| | - Heng Wang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Hao-Lin Song
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Juan Wang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
| | - Zhi-Jun Zhang
- Department of Human Anatomy, School of Medicine, Nantong University, Nantong, China
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27
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Hagedorn JM, Engle AM, George TK, Karri J, Abdullah N, Ovrom E, Bocanegra-Becerra JE, D'Souza RS. An overview of painful diabetic peripheral neuropathy: Diagnosis and treatment advancements. Diabetes Res Clin Pract 2022; 188:109928. [PMID: 35580704 DOI: 10.1016/j.diabres.2022.109928] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/12/2022] [Accepted: 05/09/2022] [Indexed: 01/09/2023]
Abstract
Diabetes mellitus remains a public health problem, affecting 422 million people worldwide. Currently, there is no consensus around treating painful diabetic peripheral neuropathy in a step-wise manner. Among the non-pharmacological interventions, neuromodulation has become a promising alternative. Over the past decade, significant clinical trials have paved the way for prompt inclusion of high-frequency spinal cord stimulation within the painful diabetic peripheral neuropathy treatment algorithm. This article aims to provide an updated evidence-based approach for the management of painful diabetic peripheral neuropathy.
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Affiliation(s)
| | - Alyson M Engle
- Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | | | - Jay Karri
- Johns Hopkins University, Baltimore, MD, USA
| | - Newaj Abdullah
- Division of Pain Medicine, Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA
| | - Erik Ovrom
- Mayo Clinic Alix School of Medicine, Rochester, MN, USA
| | | | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
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28
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Rhudy JL, Huber FA, Toledo TA, Kell PA, Street EN, Shadlow JO. Psychosocial and cardiometabolic predictors of chronic pain onset in Native Americans: serial mediation analyses of 2-year prospective data from the Oklahoma Study of Native American Pain Risk. Pain 2022; 163:e654-e674. [PMID: 34433767 PMCID: PMC8866534 DOI: 10.1097/j.pain.0000000000002458] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 07/19/2021] [Indexed: 11/25/2022]
Abstract
ABSTRACT Chronic pain results in considerable suffering, as well as significant economic and societal costs. Previous evidence suggests that Native Americans (NAs) have higher rates of chronic pain than other U.S. racial or ethnic groups, but the mechanisms contributing to this pain disparity are poorly understood. The Oklahoma Study of Native American Pain Risk was developed to address this issue and recruited healthy, pain-free NAs and non-Hispanic Whites. Cross-sectional analyses identified several measures of adversity (eg, trauma and discrimination), cognitive-affective factors (perceived stress and pain-related anxiety/catastrophizing), and cardiometabolic factors (eg, body mass index, blood pressure, and heart rate variability) that were associated with pronociceptive processes (eg, central sensitization, descending inhibition, and hyperalgesia). Every 6-months after enrollment, eligible participants (N = 277) were recontacted and assessed for the onset of chronic pain. This study examines predictors of chronic pain onset in the 222 participants (80%) who responded over the first 2 years. The results show that NAs developed chronic pain at a higher rate than non-Hispanic Whites (OR = 2.902, P < 0.05), even after controlling for age, sex, income, and education. Moreover, serial mediation models identified several potential pathways to chronic pain onset within the NA group. These paths included perceived discrimination, psychological stress, pain-related anxiety, a composite measure of cardiometabolic risk, and impaired descending inhibition of spinal nociception (assessed from conditioned pain modulation of the nociceptive flexion reflex). These results provide the first prospective evidence for a pain disparity in NAs that seems to be promoted by psychosocial, cardiometabolic, and pronociceptive mechanisms.
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Affiliation(s)
- Jamie L. Rhudy
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | | | - Tyler A. Toledo
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Parker A. Kell
- The University of Tulsa, Department of Psychology, Tulsa, OK
| | - Erin N. Street
- The University of Tulsa, Department of Psychology, Tulsa, OK
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29
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Two nested syndromes: fibromyalgia and neuropathic pain in prediabetes—a pilot study. Int J Diabetes Dev Ctries 2022. [DOI: 10.1007/s13410-021-00961-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
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30
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Hall BE, Macdonald E, Cassidy M, Yun S, Sapio MR, Ray P, Doty M, Nara P, Burton MD, Shiers S, Ray-Chaudhury A, Mannes AJ, Price TJ, Iadarola MJ, Kulkarni AB. Transcriptomic analysis of human sensory neurons in painful diabetic neuropathy reveals inflammation and neuronal loss. Sci Rep 2022; 12:4729. [PMID: 35304484 PMCID: PMC8933403 DOI: 10.1038/s41598-022-08100-8] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 02/25/2022] [Indexed: 01/02/2023] Open
Abstract
Pathological sensations caused by peripheral painful neuropathy occurring in Type 2 diabetes mellitus (T2DM) are often described as 'sharp' and 'burning' and are commonly spontaneous in origin. Proposed etiologies implicate dysfunction of nociceptive sensory neurons in dorsal root ganglia (DRG) induced by generation of reactive oxygen species, microvascular defects, and ongoing axonal degeneration and regeneration. To investigate the molecular mechanisms contributing to diabetic pain, DRGs were acquired postmortem from patients who had been experiencing painful diabetic peripheral neuropathy (DPN) and subjected to transcriptome analyses to identify genes contributing to pathological processes and neuropathic pain. DPN occurs in distal extremities resulting in the characteristic "glove and stocking" pattern. Accordingly, the L4 and L5 DRGs, which contain the perikarya of primary afferent neurons innervating the foot, were analyzed from five DPN patients and compared with seven controls. Transcriptome analyses identified 844 differentially expressed genes. We observed increases in levels of inflammation-associated transcripts from macrophages in DPN patients that may contribute to pain hypersensitivity and, conversely, there were frequent decreases in neuronally-related genes. The elevated inflammatory gene profile and the accompanying downregulation of multiple neuronal genes provide new insights into intraganglionic pathology and mechanisms causing neuropathic pain in DPN patients with T2DM.
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Affiliation(s)
- Bradford E Hall
- Functional Genomics Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 130, Bethesda, MD, 20892, USA
| | - Emma Macdonald
- Functional Genomics Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 130, Bethesda, MD, 20892, USA
- Present Affiliation: NIH Graduate Partnerships Program, Brown University, Providence, RI, 02912, USA
| | - Margaret Cassidy
- Functional Genomics Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 130, Bethesda, MD, 20892, USA
| | - Sijung Yun
- Yotta Biomed, LLC, Bethesda, MD, 20814, USA
| | - Matthew R Sapio
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Pradipta Ray
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Megan Doty
- Functional Genomics Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 130, Bethesda, MD, 20892, USA
| | - Pranavi Nara
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Michael D Burton
- Neuroimmunology and Behavior Group, School of Behavior and Brain Sciences, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Stephanie Shiers
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Abhik Ray-Chaudhury
- Surgical Neurology Branch, Disorders and Stroke, National Institute of Neurological, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Andrew J Mannes
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Theodore J Price
- Department of Neuroscience and Center for Advanced Pain Studies, University of Texas at Dallas, Richardson, TX, 75080, USA
| | - Michael J Iadarola
- Department of Perioperative Medicine, Clinical Center, National Institutes of Health, Bethesda, MD, 20892, USA
| | - Ashok B Kulkarni
- Functional Genomics Section, National Institute of Dental and Craniofacial Research, National Institutes of Health, 30 Convent Drive, Room 130, Bethesda, MD, 20892, USA.
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31
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Botta RM, Palermi S, Tarantino D. High-intensity interval training for chronic pain conditions: a narrative review. J Exerc Rehabil 2022; 18:10-19. [PMID: 35356137 PMCID: PMC8934613 DOI: 10.12965/jer.2142718.359] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 01/10/2022] [Indexed: 11/22/2022] Open
Abstract
Chronic pain is defined as pain that persists past the normal healing time. Physical activity and exercise programs are increasingly being promoted and used for a variety of chronic pain conditions. Evidence suggests that physical exercise is an intervention with few adverse events that may improve pain severity and physical function, thus improving the quality of life. High-intensity interval training (HIIT) has been shown to improve physical outcome measures and to decrease disorder-related disability in people with chronic disorders. Since an overview of the benefits of HIIT on chronic pain conditions has not been published yet, this review aims to report the effects of HIIT alone or in combination with other forms of training on different kind of chronic pain conditions. A search in the main scientific electronic databases was performed. The results of the studies included in this review showed that HIIT is beneficial for several chronic pain conditions, improving pain and physical function. Since HIIT could represent a valid help to conventional drug therapies, it could improve the quality of life of these subjects. The actual quality of evidence remains very low, and further high evidence studies are needed to confirm the promising outcomes reported in this review.
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Affiliation(s)
- Riccardo Maria Botta
- Anesthesia and Intensive Care, Department of Medical and Surgical Science, Magna Graecia University, Catanzaro,
Italy
| | - Stefano Palermi
- Department of Public Health, University of Naples Federico II, Naples,
Italy
| | - Domiziano Tarantino
- Department of Public Health, University of Naples Federico II, Naples,
Italy
- Corresponding author: Domiziano Tarantino, Department of Public Health, University of Naples Federico II, Via Sergio Pansini nr. 5, 80131 Naples, Italy,
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Maida CD, Daidone M, Pacinella G, Norrito RL, Pinto A, Tuttolomondo A. Diabetes and Ischemic Stroke: An Old and New Relationship an Overview of the Close Interaction between These Diseases. Int J Mol Sci 2022; 23:ijms23042397. [PMID: 35216512 PMCID: PMC8877605 DOI: 10.3390/ijms23042397] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 02/15/2022] [Accepted: 02/19/2022] [Indexed: 12/12/2022] Open
Abstract
Diabetes mellitus is a comprehensive expression to identify a condition of chronic hyperglycemia whose causes derive from different metabolic disorders characterized by altered insulin secretion or faulty insulin effect on its targets or often both mechanisms. Diabetes and atherosclerosis are, from the point of view of cardio- and cerebrovascular risk, two complementary diseases. Beyond shared aspects such as inflammation and oxidative stress, there are multiple molecular mechanisms by which they feed off each other: chronic hyperglycemia and advanced glycosylation end-products (AGE) promote ‘accelerated atherosclerosis’ through the induction of endothelial damage and cellular dysfunction. These diseases impact the vascular system and, therefore, the risk of developing cardio- and cerebrovascular events is now evident, but the observation of this significant correlation has its roots in past decades. Cerebrovascular complications make diabetic patients 2–6 times more susceptible to a stroke event and this risk is magnified in younger individuals and in patients with hypertension and complications in other vascular beds. In addition, when patients with diabetes and hyperglycemia experience an acute ischemic stroke, they are more likely to die or be severely disabled and less likely to benefit from the one FDA-approved therapy, intravenous tissue plasminogen activator. Experimental stroke models have revealed that chronic hyperglycemia leads to deficits in cerebrovascular structure and function that may explain some of the clinical observations. Increased edema, neovascularization, and protease expression as well as altered vascular reactivity and tone may be involved and point to potential therapeutic targets. Further study is needed to fully understand this complex disease state and the breadth of its manifestation in the cerebrovasculature.
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Affiliation(s)
- Carlo Domenico Maida
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Mario Daidone
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
- Correspondence:
| | - Gaetano Pacinella
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Rosario Luca Norrito
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonio Pinto
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
| | - Antonino Tuttolomondo
- Molecular and Clinical Medicine PhD Programme, University of Palermo, 90127 Palermo, Italy; (C.D.M.); (A.T.)
- U.O.C di Medicina Interna con Stroke Care, Dipartimento di Promozione della Salute, Materno Infantile, Medicina Interna e Specialistica di Eccellenza “G. D’Alessandro” (PROMISE), University of Palermo, Piazza delle Cliniche n.2, 90127 Palermo, Italy; (G.P.); (R.L.N.); (A.P.)
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Nigam K, Kaur A, Tyagi A, Manda K, Goswami N, Nematullah M, Khan F, Gabrani R, Gauba P, Dang S. In vitro & In vivo evaluations of PLGA nanoparticle based combinatorial drug therapy for Baclofen and Lamotrigine for neuropathic pain management. J Microencapsul 2022; 39:95-109. [PMID: 35147068 DOI: 10.1080/02652048.2022.2041751] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
AIM Baclofen and Lamotrigine via PLGA nanoparticles were developed for nose-to-brain delivery for treatment of Neuropathic pain. METHODS Nanoparticles were prepared using modified nano-precipitation method. The prepared NPs were characterized and further in vitro and in vivo studies were performed. RESULTS The Bcf-Ltg-PLGA-NPs were ∼177.7nm with >75%(w/w) drugs encapsulated. In vitro dissolution studies suggested zero-order release profiles following Korsmeyer-Peppas model. In vitro cytotoxicity and staining studies on mammalian cells showed dose dependant cytotoxicity where nanoparticles were significantly less toxic(>95% cell-viability). ELISA studies on RAW-macrophages showed Bcf-Ltg-PLGA-NPs as potential pro-inflammatory-cytokines inhibitor. In vivo gamma-scintigraphy studies on rats showed intra-nasal administration of 99mTc-Bcf-Ltg-PLGA-NPs showed Cmax 3.6%/g at Tmax=1.5h with DTE% as 191.23% and DTP% = 38.61% in brain. Pharmacodynamics evaluations on C57BL/6J mice showed significant reduction in licks/bites during inflammation induced phase II pain. CONCLUSION The findings concluded that combination of these drugs into single nanoparticle-based formulation has potential for pain management.
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Affiliation(s)
- Kuldeep Nigam
- Department of Biotechnology, Jaypee Institute of Information Technology, A-10, Sector-62, NOIDA, India, 201309
| | - Atinderpal Kaur
- Department of Biotechnology, Jaypee Institute of Information Technology, A-10, Sector-62, NOIDA, India, 201309
| | - Amit Tyagi
- Institute of Nuclear medicine and Allied Sciences, Defence Research and Development Organisation, Timarpur, Delhi, India, 110054
| | - Kailash Manda
- Institute of Nuclear medicine and Allied Sciences, Defence Research and Development Organisation, Timarpur, Delhi, India, 110054
| | - Nidhi Goswami
- Institute of Nuclear medicine and Allied Sciences, Defence Research and Development Organisation, Timarpur, Delhi, India, 110054
| | - Md Nematullah
- Department of Biochemistry, Faculty of Science, Jamia Hamdard, New Delhi, India, 110062
| | - Farah Khan
- Department of Biochemistry, Faculty of Science, Jamia Hamdard, New Delhi, India, 110062
| | - Reema Gabrani
- Department of Biotechnology, Jaypee Institute of Information Technology, A-10, Sector-62, NOIDA, India, 201309
| | - Pammi Gauba
- Department of Biotechnology, Jaypee Institute of Information Technology, A-10, Sector-62, NOIDA, India, 201309
| | - Shweta Dang
- Department of Biotechnology, Jaypee Institute of Information Technology, A-10, Sector-62, NOIDA, India, 201309
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Rashid M, Alkhodari M, Mukit A, Ahmed KIU, Mostafa R, Parveen S, Khandoker AH. Machine Learning for Screening Microvascular Complications in Type 2 Diabetic Patients Using Demographic, Clinical, and Laboratory Profiles. J Clin Med 2022; 11:jcm11040903. [PMID: 35207179 PMCID: PMC8879306 DOI: 10.3390/jcm11040903] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 01/23/2022] [Accepted: 01/30/2022] [Indexed: 12/30/2022] Open
Abstract
Microvascular complications are one of the key causes of mortality among type 2 diabetic patients. This study was sought to investigate the use of a novel machine learning approach for predicting these complications using only the patient demographic, clinical, and laboratory profiles. A total of 96 Bangladeshi participants with type 2 diabetes were recruited during their routine hospital visits. All patient profiles were assessed by using a chi-squared (χ2) test to statistically determine the most important markers in predicting three microvascular complications: cardiac autonomic neuropathy (CAN), diabetic peripheral neuropathy (DPN), and diabetic retinopathy (RET). A machine learning approach based on logistic regression, random forest (RF), and support vector machine (SVM) algorithms was then developed to ensure automated clinical testing for microvascular complications in diabetic patients. The highest prediction accuracies were obtained by RF using diastolic blood pressure, albumin–creatinine ratio, and gender for CAN testing (98.67%); microalbuminuria, smoking history, and hemoglobin A1C for DPN testing (67.78%); and hemoglobin A1C, microalbuminuria, and smoking history for RET testing (84.38%). This study suggests machine learning as a promising automated tool for predicting microvascular complications in diabetic patients using their profiles, which could help prevent those patients from further microvascular complications leading to early death.
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Affiliation(s)
- Mamunur Rashid
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Mohanad Alkhodari
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
- Correspondence:
| | - Abdul Mukit
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
- Department of Electrical and Computer Engineering, University of Oklahoma, Tulsa, OK 74135, USA
| | - Khawza Iftekhar Uddin Ahmed
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Raqibul Mostafa
- Department of Electrical and Electronic Engineering, United International University, Dhaka 1212, Bangladesh; (M.R.); (A.M.); (K.I.U.A.); (R.M.)
| | - Sharmin Parveen
- Department of Health Informatics, Bangladesh University of Health Sciences, Dhaka 1216, Bangladesh;
| | - Ahsan H. Khandoker
- Healthcare Engineering Innovation Center (HEIC), Department of Biomedical Engineering, Khalifa University, Abu Dhabi 127788, United Arab Emirates;
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Price R, Smith D, Franklin G, Gronseth G, Pignone M, David WS, Armon C, Perkins BA, Bril V, Rae-Grant A, Halperin J, Licking N, O'Brien MD, Wessels SR, MacGregor LC, Fink K, Harkless LB, Colbert L, Callaghan BC. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology 2022; 98:31-43. [PMID: 34965987 DOI: 10.1212/wnl.0000000000013038] [Citation(s) in RCA: 64] [Impact Index Per Article: 32.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 10/15/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To update the 2011 American Academy of Neurology (AAN) guideline on the treatment of painful diabetic neuropathy (PDN) with a focus on topical and oral medications and medical class effects. METHODS The authors systematically searched the literature from January 2008 to April 2020 using a structured review process to classify the evidence and develop practice recommendations using the AAN 2017 Clinical Practice Guideline Process Manual. RESULTS Gabapentinoids (standardized mean difference [SMD] 0.44; 95% confidence interval [CI], 0.21-0.67), serotonin-norepinephrine reuptake inhibitors (SNRIs) (SMD 0.47; 95% CI, 0.34-0.60), sodium channel blockers (SMD 0.56; 95% CI, 0.25-0.87), and SNRI/opioid dual mechanism agents (SMD 0.62; 95% CI, 0.38-0.86) all have comparable effect sizes just above or just below our cutoff for a medium effect size (SMD 0.5). Tricyclic antidepressants (TCAs) (SMD 0.95; 95% CI, 0.15-1.8) have a large effect size, but this result is tempered by a low confidence in the estimate. RECOMMENDATIONS SUMMARY Clinicians should assess patients with diabetes for PDN (Level B) and those with PDN for concurrent mood and sleep disorders (Level B). In patients with PDN, clinicians should offer TCAs, SNRIs, gabapentinoids, and/or sodium channel blockers to reduce pain (Level B) and consider factors other than efficacy (Level B). Clinicians should offer patients a trial of medication from a different effective class when they do not achieve meaningful improvement or experience significant adverse effects with the initial therapeutic class (Level B) and not use opioids for the treatment of PDN (Level B).
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Affiliation(s)
- Raymond Price
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Don Smith
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Gary Franklin
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Gary Gronseth
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Michael Pignone
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - William S David
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Carmel Armon
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Bruce A Perkins
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Vera Bril
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Alexander Rae-Grant
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - John Halperin
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Nicole Licking
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Mary Dolan O'Brien
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Scott R Wessels
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor.
| | - Leslie C MacGregor
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Kenneth Fink
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Lawrence B Harkless
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Lindsay Colbert
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
| | - Brian C Callaghan
- From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor
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Callaghan BC, Armon C, Bril V, Colbert L, David WS, Del Toro DR, Fink K, Jones LK, Kleemeier R, MacGregor LC, Bennett A, Shenoy A. Polyneuropathy Quality Measurement Set: Quality Improvement in Neurology. Neurology 2022; 98:22-30. [PMID: 34965986 DOI: 10.1212/wnl.0000000000013037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 10/07/2021] [Indexed: 11/15/2022] Open
Affiliation(s)
- Brian C Callaghan
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Carmel Armon
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Vera Bril
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Lindsay Colbert
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - William S David
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - David R Del Toro
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Kenneth Fink
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Lyell K Jones
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Robert Kleemeier
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Leslie C MacGregor
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
| | - Amy Bennett
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA.
| | - Anant Shenoy
- From the Department of Neurology (B.C.C.), University of Michigan, Ann Arbor; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine, Israel; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; The Foundation for Peripheral Neuropathy (L.C.); Buffalo Grove, IL; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Physical Medicine and Rehabilitation (D.R.D.T.), Medical College of Wisconsin, Milwaukee; Kamehameha Schools (K.F.), Honolulu, HI; Department of Neurology (L.K.J.), Mayo Clinic, Rochester, MN; Minnesota Neuropathy Association (R.K.), Eau Claire, WI; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; American Academy of Neurology (A.B.), Minneapolis, MN; and Division of Neurology (A.S.), Mount Auburn Hospital, Springfield, MA
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Sloan G, Alam U, Selvarajah D, Tesfaye S. The Treatment of Painful Diabetic Neuropathy. Curr Diabetes Rev 2022; 18:e070721194556. [PMID: 34238163 DOI: 10.2174/1573399817666210707112413] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 02/18/2021] [Accepted: 03/08/2021] [Indexed: 11/22/2022]
Abstract
Painful diabetic peripheral neuropathy (painful-DPN) is a highly prevalent and disabling condition, affecting up to one-third of patients with diabetes. This condition can have a profound impact resulting in a poor quality of life, disruption of employment, impaired sleep, and poor mental health with an excess of depression and anxiety. The management of painful-DPN poses a great challenge. Unfortunately, currently there are no Food and Drug Administration (USA) approved disease-modifying treatments for diabetic peripheral neuropathy (DPN) as trials of putative pathogenetic treatments have failed at phase 3 clinical trial stage. Therefore, the focus of managing painful- DPN other than improving glycaemic control and cardiovascular risk factor modification is treating symptoms. The recommended treatments based on expert international consensus for painful- DPN have remained essentially unchanged for the last decade. Both the serotonin re-uptake inhibitor (SNRI) duloxetine and α2δ ligand pregabalin have the most robust evidence for treating painful-DPN. The weak opioids (e.g. tapentadol and tramadol, both of which have an SNRI effect), tricyclic antidepressants such as amitriptyline and α2δ ligand gabapentin are also widely recommended and prescribed agents. Opioids (except tramadol and tapentadol), should be prescribed with caution in view of the lack of definitive data surrounding efficacy, concerns surrounding addiction and adverse events. Recently, emerging therapies have gained local licenses, including the α2δ ligand mirogabalin (Japan) and the high dose 8% capsaicin patch (FDA and Europe). The management of refractory painful-DPN is difficult; specialist pain services may offer off-label therapies (e.g. botulinum toxin, intravenous lidocaine and spinal cord stimulation), although there is limited clinical trial evidence supporting their use. Additionally, despite combination therapy being commonly used clinically, there is little evidence supporting this practise. There is a need for further clinical trials to assess novel therapeutic agents, optimal combination therapy and existing agents to determine which are the most effective for the treatment of painful-DPN. This article reviews the evidence for the treatment of painful-DPN, including emerging treatment strategies such as novel compounds and stratification of patients according to individual characteristics (e.g. pain phenotype, neuroimaging and genotype) to improve treatment responses.
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Affiliation(s)
- Gordon Sloan
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
| | - Uazman Alam
- Department of Cardiovascular and Metabolic Medicine and the Pain Research Institute, Institute of Life Course and Medical Sciences, University of Liverpool, and Liverpool University Hospital, NHS Foundation Trust, Liverpool, UK
- Division of Diabetes, Endocrinology and Gastroenterology, Institute of Human Development, University of Manchester, Manchester, UK
| | - Dinesh Selvarajah
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
- Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK
| | - Solomon Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals, NHS Foundation Trust, Sheffield, UK
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Åström MJ, von Bonsdorff MB, Haanpää M, Salonen MK, Kautiainen H, Eriksson JG. Glucose regulation and pain in older people-The Helsinki Birth Cohort Study. Prim Care Diabetes 2021; 15:561-566. [PMID: 33579570 DOI: 10.1016/j.pcd.2021.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 01/27/2021] [Accepted: 02/01/2021] [Indexed: 11/21/2022]
Abstract
AIMS To assess if individuals with diabetes or prediabetes report more pain or have increased use of pain medication compared to normoglycaemic individuals. METHODS Using cross-sectional data, we studied 928 men and 1075 women from the Helsinki Birth Cohort Study in 2001-2004 at a mean age of 61.5 years. Glucose regulation was assessed with a 2-h 75 g oral glucose tolerance test, and applying World Health Organization criteria, participants were defined as having normoglycaemia, prediabetes (impaired fasting glucose or impaired glucose tolerance), newly diagnosed diabetes or previously diagnosed diabetes. Self-reported pain intensity and interference during the previous 4 weeks was estimated using the RAND 36-Item Health Survey 1.0. Information on use of pain medication during the past 12 months was obtained from the Social Insurance Institution of Finland. RESULTS There was no difference in pain intensity or interference between glucose regulation groups for neither men nor women after adjusting for covariates (age, body mass index, education years, Beck Depression Inventory and physical activity). In addition, use of pain medication was similar between glucose regulation groups. CONCLUSIONS Although pain is a common symptom in the general population, impairments in glucose regulation alone does not seem to increase pain among older individuals.
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Affiliation(s)
- Max J Åström
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Vaasa Central Hospital, Vaasa, Finland.
| | - Mikaela B von Bonsdorff
- Folkhälsan Research Center, Helsinki, Finland; Gerontology Research Center and Faculty of Sport and Health Sciences, University of Jyväskylä, Jyväskylä, Finland
| | - Maija Haanpää
- Department of Neurosurgery, Helsinki University Central Hospital, Helsinki, Finland; Ilmarinen Mutual Pension Insurance Company, Vantaa, Finland
| | - Minna K Salonen
- Folkhälsan Research Center, Helsinki, Finland; Department of Public Health Solutions, Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - Hannu Kautiainen
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland
| | - Johan G Eriksson
- Department of General Practice and Primary Health Care, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; Folkhälsan Research Center, Helsinki, Finland; Department of Public Health Solutions, Public Health Promotion Unit, National Institute for Health and Welfare, Helsinki, Finland; Singapore Institute for Clinical Sciences (SICS), Agency for Science, Technology and Research (A*STAR), Singapore, Singapore; Obstetrics & Gynecology, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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Gupta M, Knezevic NN, Abd-Elsayed A, Ray M, Patel K, Chowdhury B. Treatment of Painful Diabetic Neuropathy-A Narrative Review of Pharmacological and Interventional Approaches. Biomedicines 2021; 9:biomedicines9050573. [PMID: 34069494 PMCID: PMC8161066 DOI: 10.3390/biomedicines9050573] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 05/01/2021] [Accepted: 05/06/2021] [Indexed: 12/11/2022] Open
Abstract
Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus that is associated with a significant decline in quality of life. Like other painful neuropathic conditions, PDN is difficult to manage clinically, and a variety of pharmacological and non-pharmacological options are available for this condition. Recommended pharmacotherapies include anticonvulsive agents, antidepressant drugs, and topical capsaicin; and tapentadol, which combines opioid agonism and norepinephrine reuptake inhibition, has also recently been approved for use. Additionally, several neuromodulation therapies have been successfully used for pain relief in PDN, including intrathecal therapy, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). Recently, 10 kHz SCS has been shown to provide clinically meaningful pain relief for patients refractory to conventional medical management, with a subset of patients demonstrating improvement in neurological function. This literature review is intended to discuss the dosage and prospective data associated with pain management therapies for PDN.
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Affiliation(s)
- Mayank Gupta
- Kansas Pain Management & Neuroscience Research Center, Overland Park, KS 66201, USA;
- Correspondence:
| | - Nebojsa Nick Knezevic
- Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA;
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, University of Wisconsin School of Medicine and Public Health, Madison, WI 53715, USA;
| | - Mahoua Ray
- Kansas Pain Management & Neuroscience Research Center, Overland Park, KS 66201, USA;
| | - Kiran Patel
- Department of Pain Management, Spine and Pain Institute of New York, New York, NY 10065, USA;
| | - Bhavika Chowdhury
- Department of Endocrinology, Saint Luke’s South Hospital, Overland Park, KS 66213, USA;
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Jensen TS, Karlsson P, Gylfadottir SS, Andersen ST, Bennett DL, Tankisi H, Finnerup NB, Terkelsen AJ, Khan K, Themistocleous AC, Kristensen AG, Itani M, Sindrup SH, Andersen H, Charles M, Feldman EL, Callaghan BC. Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management. Brain 2021; 144:1632-1645. [PMID: 33711103 DOI: 10.1093/brain/awab079] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 02/15/2021] [Accepted: 02/21/2021] [Indexed: 12/12/2022] Open
Abstract
Peripheral neuropathy is one of the most common complications of both type 1 and type 2 diabetes. Up to half of patients with diabetes develop neuropathy during the course of their disease, which is accompanied by neuropathic pain in 30-40% of cases. Peripheral nerve injury in diabetes can manifest as progressive distal symmetric polyneuropathy, autonomic neuropathy, radiculo-plexopathies, and mononeuropathies. The most common diabetic neuropathy is distal symmetric polyneuropathy, which we will refer to as DN, with its characteristic glove and stocking like presentation of distal sensory or motor function loss. DN or its painful counterpart, painful DN, are associated with increased mortality and morbidity; thus, early recognition and preventive measures are essential. Nevertheless, it is not easy to diagnose DN or painful DN, particularly in patients with early and mild neuropathy, and there is currently no single established diagnostic gold standard. The most common diagnostic approach in research is a hierarchical system, which combines symptoms, signs, and a series of confirmatory tests. The general lack of long-term prospective studies has limited the evaluation of the sensitivity and specificity of new morphometric and neurophysiological techniques. Thus, the best paradigm for screening DN and painful DN both in research and in clinical practice remains uncertain. Herein, we review the diagnostic challenges from both clinical and research perspectives and their implications for managing patients with DN. There is no established DN treatment, apart from improved glycaemic control, which is more effective in type 1 than in type 2 diabetes, and only symptomatic management is available for painful DN. Currently, less than one-third of patients with painful DN derive sufficient pain relief with existing pharmacotherapies. A more precise and distinct sensory profile from patients with DN and painful DN may help identify responsive patients to one treatment versus another. Detailed sensory profiles will lead to tailored treatment for patient subgroups with painful DN by matching to novel or established DN pathomechanisms and also for improved clinical trials stratification. Large randomized clinical trials are needed to identify the interventions, i.e. pharmacological, physical, cognitive, educational, etc., which lead to the best therapeutic outcomes.
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Affiliation(s)
- Troels S Jensen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Pall Karlsson
- Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Sandra S Gylfadottir
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Signe T Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Department of Public Health, Aarhus University, Aarhus, Denmark
| | - David L Bennett
- Nuffield Department of Clinical Neuroscience, Oxford University, Oxford, UK
| | - Hatice Tankisi
- Department of Neurophysiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Astrid J Terkelsen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark.,Danish Pain Research Center, Aarhus University, Aarhus, Denmark
| | - Karolina Khan
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | | | | | - Mustapha Itani
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Søren H Sindrup
- Department of Neurology, Odense University Hospital, Odense, Denmark
| | - Henning Andersen
- Department of Neurology, Aarhus University Hospital, Aarhus, Denmark
| | - Morten Charles
- Department of Public Health, Aarhus University, Aarhus, Denmark
| | - Eva L Feldman
- Department of Neurology, University of Michigan, Ann Arbor, MI, USA
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Nalini M, Khoshnia M, Kamangar F, Sharafkhah M, Poustchi H, Pourshams A, Roshandel G, Gharavi S, Zahedi M, Norouzi A, Sotoudeh M, Nikmanesh A, Brennan P, Boffetta P, Dawsey SM, Abnet CC, Malekzadeh R, Etemadi A. Joint effect of diabetes and opiate use on all-cause and cause-specific mortality: the Golestan cohort study. Int J Epidemiol 2021; 50:314-324. [PMID: 32810213 PMCID: PMC7938504 DOI: 10.1093/ije/dyaa126] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/23/2020] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Many diabetic individuals use prescription and non-prescription opioids and opiates. We aimed to investigate the joint effect of diabetes and opiate use on all-cause and cause-specific mortality. METHODS Golestan Cohort study is a prospective population-based study in Iran. A total of 50 045 people-aged 40-75, 28 811 women, 8487 opiate users, 3548 diabetic patients-were followed during a median of 11.1 years, with over 99% success follow-up. Hazard ratio and 95% confidence intervals (HRs, 95% CIs), and preventable death attributable to each risk factor, were calculated. RESULTS After 533 309 person-years, 7060 deaths occurred: 4178 (10.8%) of non-diabetic non-opiate users, 757 (25.3%) diabetic non-users, 1906 (24.0%) non-diabetic opiate users and 219 (39.8%) diabetic opiate users. Compared with non-diabetic non-users, HRs (95% CIs) for all-cause mortality were 2.17 (2.00-2.35) in diabetic non-opiate users, 1.63 (1.53-1.74) in non-diabetic opiate users and 2.76 (2.40-3.17) in diabetic opiate users. Among those who both had diabetes and used opiates, 63.8% (95% CI: 58.3%-68.5%) of all deaths were attributable to these risk factors, compared with 53.9% (95% CI: 50%-57.4%) in people who only had diabetes and 38.7% (95% CI: 34.6%-42.5%) in non-diabetic opiate users. Diabetes was more strongly associated with cardiovascular than cancer mortality. The risk of early mortality in known cases of diabetes did not depend on whether they started opiate use before or after their diagnosis. CONCLUSIONS Using opiates is detrimental to the health of diabetic patients. Public awareness about the health effects of opiates, and improvement of diabetes care especially among individuals with or at risk of opiate use, are necessary.
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Affiliation(s)
- Mahdi Nalini
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Cardiovascular Research Center, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Masoud Khoshnia
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Farin Kamangar
- Department of Biology, School of Computer, Mathematical, and Natural Sciences, Morgan State University, Baltimore, MD, USA
| | - Maryam Sharafkhah
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Hossein Poustchi
- Liver and Pancreaticobilliary Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Akram Pourshams
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Gholamreza Roshandel
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Samad Gharavi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Mahdi Zahedi
- Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Alireza Norouzi
- Golestan Research Center of Gastroenterology and Hepatology (GRCGH), Golestan University of Medical Sciences, Gorgan, Iran
| | - Masoud Sotoudeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Nikmanesh
- Digestive Disease Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Sasan Alborz Research Center, Masoud Clinic, Tehran, Iran
| | - Paul Brennan
- Section of Genetics, International Agency for Research on Cancer, Lyon, France
| | - Paolo Boffetta
- Tisch Cancer Institute, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy
| | - Sanford M Dawsey
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Christian C Abnet
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
| | - Reza Malekzadeh
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Arash Etemadi
- Digestive Oncology Research Center, Digestive Disease Research Institute, Tehran University of Medical Sciences, Tehran, Iran
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, USA
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Role of interdigital sensory nerve conduction study as a noninvasive approach for early diagnosis of diabetic peripheral neuropathy. J Diabetes Metab Disord 2021; 20:71-75. [PMID: 34178823 DOI: 10.1007/s40200-020-00710-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 12/16/2020] [Indexed: 10/22/2022]
Abstract
Purpose Diabetes mellitus is amongst the most common causes of polyneuropathy worldwide that can eventually terminate to irreversible complications. The remarkable impact of diabetic polyneuropathy as a debilitating condition on the healthcare system and total costs of diabetes care is undeniable. Despite the existence of numerous diagnostic tools such as routine electrophysiologic procedures, its early detection is challenging. This study designed to compare more distal techniques of electrodiagnostic testing, including interdigital sensory nerve conduction studies (NCSs), with conventional approaches and to investigate its role in confirming the early stages of polyneuropathy. Methods This cross-sectional study was performed in the Physical Medicine and Rehabilitation Department of Hazrat Fatemeh Reconstruction Surgery Hospital. Thirty one symptomatic diabetic outpatients and 23 asymptomatic nondiabetic subjects included in our study. We performed nerve conduction studies on five sensory nerves consist of the dorsal sural nerve, medial plantar nerve, digital branches of the interdigital nerves to toes I, II, and III (as a new antidromic technique). In this study, all techniques applied with a surface stimulator and pick-up electrodes. Results In the group of patients, 9 (29%) and 22 (71%) subjects had impaired and normal routine NCSs, respectively. Interestingly, the results of interdigital nerve studies were abnormal in the 17 out of 22 patients with normal routine NCSs. Also, 11 and 13 subjects had impaired medial plantar nerve and dorsal sural nerve conduction studies, respectively. Accordingly, with this new method, the prevalence of detectable diabetic neuropathy increased from 46% to 83%. Discussion We conducted this study intending to demonstrate the application of a new technique for early diagnosis of diabetic polyneuropathy, especially in the presymptomatic and subclinical neuropathies. The digital sensory branches of IDNs known as the most distal sensory nerves, which can be easily evaluated with new antidromic SNAP technique. Our method is simple, non-invasive, suitable, sensitive, and reproducible. There is no need to needle electrode or averaging technique to record an appropriate amplitude of IDN. Thus, it is recommended as a convenient electrophysiological option for early diagnosis of DPN.
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Diabetic polyneuropathy and pain, prevalence, and patient characteristics: a cross-sectional questionnaire study of 5,514 patients with recently diagnosed type 2 diabetes. Pain 2021; 161:574-583. [PMID: 31693539 PMCID: PMC7017941 DOI: 10.1097/j.pain.0000000000001744] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Supplemental Digital Content is Available in the Text. Diabetic polyneuropathy and painful diabetic polyneuropathy are frequent in early type 2 diabetes, associated with modifiable risk factors, and have major impact on mental health. Most studies of diabetic polyneuropathy (DPN) and painful DPN are conducted in persons with longstanding diabetes. This cross-sectional study aimed to estimate the prevalence of DPN and painful DPN, important risk factors, and the association with mental health in recently diagnosed type 2 diabetes. A total of 5514 (82%) patients (median diabetes duration 4.6 years) enrolled in the Danish Centre for Strategic Research in Type 2 Diabetes cohort responded to a detailed questionnaire on neuropathy and pain. A score ≥4 on the MNSI questionnaire determined possible DPN, whereas pain presence in both feet together with a score ≥3 on the DN4 questionnaire determined possible painful DPN. The prevalence of possible DPN and possible painful DPN was 18% and 10%, respectively. Female sex, age, diabetes duration, body mass index, and smoking were associated with possible DPN, whereas only smoking showed a clear association with possible painful DPN (odds ratio 1.52 [95% confidence interval: 1.20-1.93]). Possible DPN and painful DPN were independently and additively associated with lower quality of life, poorer sleep, and symptoms of depression and anxiety. Possible DPN itself had greater impact on mental health than neuropathic pain. This large study emphasizes the importance of careful screening for DPN and pain early in the course of type 2 diabetes.
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Zhu YB, Jia GL, Wang JW, Ye XY, Lu JH, Chen JL, Zhang MB, Xie CS, Shen YJ, Tao YX, Li J, Cao H. Activation of CaMKII and GluR1 by the PSD-95-GluN2B Coupling-Dependent Phosphorylation of GluN2B in the Spinal Cord in a Rat Model of Type-2 Diabetic Neuropathic Pain. J Neuropathol Exp Neurol 2020; 79:800-808. [PMID: 32386416 DOI: 10.1093/jnen/nlaa035] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 04/02/2020] [Indexed: 12/29/2022] Open
Abstract
The mechanisms underlying type-2 diabetic neuropathic pain (DNP) are unclear. This study investigates the coupling of postsynaptic density-95 (PSD-95) to N-methyl-D-aspartate receptor subunit 2B (GluN2B), and the subsequent phosphorylation of GluN2B (Tyr1472-GluN2B) in the spinal cord in a rat model of type-2 DNP. Expression levels of PSD-95, Tyr1472-GluN2B, Ca2+/calmodulin-dependent protein kinase II (CaMKII) and its phosphorylated counterpart (Thr286-CaMKII), and α-amino-3-hydroxy-5-methyl-4-soxazole propionic acid receptor subtype 1 (GluR1) and its phosphorylated counterpart (Ser831-GluR1) were significantly increased versus controls in the spinal cord of type-2 DNP rats whereas the expression of total spinal GluN2B did not change. The intrathecal injection of Ro25-6981 (a specific antagonist of GluN2B) or Tat-NR2B9c (a mimetic peptide disrupting the interaction between PSD-95 and GluN2B) induced an antihyperalgesic effect and blocked the increased expression of Tyr1472-GluN2B, CaMKII, GluR1, Thr286-CaMKII, and Ser831-GluR1 in the spinal cords; the increase in spinal cord PSD-95 was not affected. These findings indicate that the PSD-95-GluN2B interaction may increase phosphorylation of GluN2B, and subsequently induce the expression of phosphorylation of CaMKII and GluR1 in the spinal cord of type-2 DNP rats. Targeting the interaction of PSD-95 with GluN2B may provide a new therapeutic strategy for type-2 DNP.
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Affiliation(s)
- Ya-Bing Zhu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China.,Department of Anesthesiology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Gai-Li Jia
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Jun-Wu Wang
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Xiu-Ying Ye
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Jia-Hui Lu
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Jia-Li Chen
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Mao-Biao Zhang
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Ci-Shan Xie
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Yu-Jing Shen
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Yuan-Xiang Tao
- Department of Anesthesiology, New Jersey Medical School, Rutgers, The State University of New Jersey, Newark, New Jersey
| | - Jun Li
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
| | - Hong Cao
- Department of Anesthesiology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Pain Medicine Institute of Wenzhou Medical University, Zhejiang, China
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Wang LQ, Wang F, Wang XH. Effectiveness of warm needling acupuncture for pain relief in patients with diabetic peripheral neuropathy: A protocol of systematic review. Medicine (Baltimore) 2020; 99:e23077. [PMID: 33157973 PMCID: PMC7647546 DOI: 10.1097/md.0000000000023077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/13/2020] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Warm needling acupuncture (WNA) has been widely utilized for pain management in patients with diabetic peripheral neuropathy (DPN). However, its results are still inconsistent, and no systematic review has specifically addressed this issue. Thus, this systematic review will comprehensively and systematically investigate the effectiveness and safety of WNA for pain relief in DPN. METHODS A comprehensive literature search of MEDLINE, EMBASE, Cochrane Library, Web of Science, Scopus, Allied and Complementary Medicine Database, CBM database, and China National Knowledge Infrastructure will be performed for randomized controlled trials that report WNA for pain relief in patients with DPN. All electronic databases will be searched from initial to the present without limitations of language and publication status. Two investigators will independently screen papers, collect data, and assess study quality. Cochrane risk of bias tool will be used for study quality assessment, and evidence quality will be evaluated using Grading of Recommendations Assessment, Development and Evaluations approach. RevMan 5.3 software will be applied for running statistical analysis. RESULTS This study will summarize the evidence for the effectiveness and safety of WNA for the management of pain in patients with DPN. CONCLUSIONS The findings of this study may provide helpful evidence to judge whether WNA for pain relief in DPN is effective or not.
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Affiliation(s)
| | - Fei Wang
- Department of First Clinical Medicine
| | - Xue-hui Wang
- Department of Respiratory Medicine, First Affiliated Hospital of Heilongjiang University of Chinese Medicine, Harbin, China
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Kioskli K, Scott W, Winkley K, Godfrey E, McCracken LM. Online Acceptance and Commitment Therapy for People with Painful Diabetic Neuropathy in the United Kingdom: A Single-Arm Feasibility Trial. PAIN MEDICINE (MALDEN, MASS.) 2020; 21:2777-2788. [PMID: 32358608 PMCID: PMC7685693 DOI: 10.1093/pm/pnaa110] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVE This study aimed to assess the feasibility of online Acceptance and Commitment Therapy for painful diabetic neuropathy in the United Kingdom and to determine if a larger randomized controlled trial testing treatment efficacy is justified. METHODS Participants with painful diabetic neuropathy were recruited online and from hospital services. This was a single-arm study in which all participants received online Acceptance and Commitment Therapy. Participants completed questionnaires at baseline and three months post-treatment. Primary feasibility outcomes were recruitment, retention, and treatment completion rates. Secondary outcomes were pre- to post-treatment effects on pain outcomes and psychological flexibility. RESULTS Of 225 potentially eligible participants, 30 took part in this study. Regarding primary feasibility outcomes, the treatment completion and follow-up questionnaire completion rates were 40% and 100%, respectively. Generally, at baseline those who completed the treatment, compared with those who did not, had better daily functioning and higher psychological flexibility. With respect to secondary outcomes, results from the completers group showed clinically meaningful effects at post-treatment for 100% of participants for pain intensity and pain distress, 66.7% for depressive symptoms, 58.3% for functional impairment, 41.7% for cognitive fusion, 66.7% for committed action, 58.3% for self-as-context, and 41.7% for pain acceptance. CONCLUSIONS This preliminary trial suggests feasibility of recruitment and follow-up questionnaire completion rates, supporting planning for a larger randomized controlled trial. However, treatment completion rates did not achieve the prespecified feasibility target. Changes to the treatment content and delivery may enhance the feasibility of online Acceptance and Commitment Therapy for people with painful diabetic neuropathy on a larger scale.
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Affiliation(s)
- Kitty Kioskli
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
| | - Whitney Scott
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- Guy’s and St Thomas’ NHS Foundation Trust, London, UK
| | - Kirsty Winkley
- King’s College London, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care, London, UK
| | - Emma Godfrey
- Health Psychology Section, Psychology Department, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
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Higgins DM, Heapy AA, Buta E, LaChappelle KM, Serowik KL, Czlapinski R, Kerns RD. A randomized controlled trial of cognitive behavioral therapy compared with diabetes education for diabetic peripheral neuropathic pain. J Health Psychol 2020; 27:649-662. [PMID: 33070667 DOI: 10.1177/1359105320962262] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
A randomized controlled trial compared cognitive behavioral therapy (CBT) and diabetes education (ED) as an adjunctive treatment for diabetic peripheral neuropathic pain (DPNP). We examined change from baseline to 12- and 36-week follow-up in overall pain intensity (NRS), neuropathic pain intensity/quality, pain interference, and mental health functioning, among others. Although CBT participants demonstrated improvement in pain intensity NRS, there were no between-condition differences at either follow-up. CBT reduced neuropathic pain intensity at 12-weeks more than ED. At 36-weeks, CBT was superior to ED for improving pain interference and mental health functioning. Results provide evidence of benefit of CBT for DPNP. ClinicalTrials.gov Identifier: NCT00830011
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Affiliation(s)
- Diana M Higgins
- VA Boston Healthcare System, Boston, MA, USA
- Boston University School of Medicine, Boston, MA, USA
| | - Alicia A Heapy
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | - Eugenia Buta
- Yale School of Public Health, New Haven, CT, USA
| | | | - Kristin L Serowik
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
| | | | - Robert D Kerns
- VA Connecticut Healthcare System, West Haven, CT, USA
- Yale School of Medicine, New Haven, CT, USA
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ERTUR E, VURAL KESKİNLER M, ÇAKIR İB, ERBAKAN A, OĞUZ A. Tip 2 Diyabetli Hastalarda Diyabetik Periferik Nöropati Sıklığı, İlişkili Faktörler ve Farkındalık Durumunun Değerlendirilmesi. KOCAELI ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2020. [DOI: 10.30934/kusbed.669099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Ponirakis G, Elhadd T, Chinnaiyan S, Hamza AH, Sheik S, Kalathingal MA, Anodiyil MS, Dabbous Z, Siddique MA, Almuhannadi H, Petropoulos IN, Khan A, Ae Ashawesh K, Dukhan KM, Mahfoud ZR, Zirie MA, Jayyousi A, Murgatroyd C, Slevin M, Malik RA. Prevalence and risk factors for diabetic neuropathy and painful diabetic neuropathy in primary and secondary healthcare in Qatar. J Diabetes Investig 2020; 12:592-600. [PMID: 32799429 PMCID: PMC8015833 DOI: 10.1111/jdi.13388] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 08/06/2020] [Accepted: 08/10/2020] [Indexed: 02/07/2023] Open
Abstract
Aims/Introduction This study determined the prevalence and risk factors for diabetic peripheral neuropathy (DPN) and painful DPN (pDPN) in patients with type 2 diabetes in primary healthcare (PHC) and secondary healthcare (SHC) in Qatar. Materials and Methods This was a cross‐sectional multicenter study. Adults with type 2 diabetes were randomly enrolled from four PHC centers and two diabetes centers in SHC in Qatar. Participants underwent assessment of clinical and metabolic parameters, DPN and pDPN. Results A total of 1,386 individuals with type 2 diabetes (297 from PHC and 1,089 from SHC) were recruited. The prevalence of DPN (14.8% vs 23.9%, P = 0.001) and pDPN (18.1% vs 37.5%, P < 0.0001) was significantly lower in PHC compared with SHC, whereas those with DPN at high risk for diabetic foot ulceration (31.8% vs 40.0%, P = 0.3) was comparable. The prevalence of undiagnosed DPN (79.5% vs 82.3%, P = 0.66) was comparably high, but undiagnosed pDPN (24.1% vs 71.5%, P < 0.0001) was lower in PHC compared with SHC. The odds of DPN and pDPN increased with age and diabetes duration, and DPN increased with poor glycemic control, hyperlipidemia and hypertension, whereas pDPN increased with obesity and reduced physical activity. Conclusions The prevalence of DPN and pDPN in type 2 diabetes is lower in PHC compared with SHC, and is attributed to overall better control of risk factors and referral bias due to patients with poorly managed complications being referred to SHC. However, approximately 80% of patients had not been previously diagnosed with DPN in PHC and SHC. Furthermore, we identified a number of modifiable risk factors for PDN and pDPN.
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Affiliation(s)
- Georgios Ponirakis
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Tarik Elhadd
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Subitha Chinnaiyan
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abdul H Hamza
- Umm Ghuwailina Primary Health Care, Umm Ghuwailina, Qatar
| | | | | | | | - Zeinab Dabbous
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Mashhood A Siddique
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Hamad Almuhannadi
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | | | - Adnan Khan
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Khaled Ae Ashawesh
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Khaled M Dukhan
- National Diabetes Center, Al-Wakra Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Ziyad R Mahfoud
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar
| | - Mahmoud A Zirie
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Amin Jayyousi
- National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Mark Slevin
- Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK
| | - Rayaz A Malik
- Weill Cornell Medicine-Qatar, Qatar Foundation, Education City, Doha, Qatar.,Faculty of Science and Engineering, Manchester Metropolitan University, Manchester, UK.,National Diabetes Center, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar.,Institute of Cardiovascular Science, University of Manchester, Manchester, UK
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Ren X, Yang R, Li L, Xu X, Liang S. Long non coding RNAs involved in MAPK pathway mechanism mediates diabetic neuropathic pain. Cell Biol Int 2020; 44:2372-2379. [PMID: 32844535 DOI: 10.1002/cbin.11457] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Diabetes is the largest global epidemic of the 21st century, and the cost of diabetes and its complications comprise about 12% of global health expenditure. Diabetic neuropathy is the most common complication of diabetes, affecting up to 50% of patients over the course of their disease. Among them, 30%-50% develop neuropathic pain, which has typical symptoms that originate from the toes and progress to foot ulcers and seriously influence quality of life. The pathogenesis of diabetic neuropathic pain (DNP) is complicated and incompletely understood and there is no effective treatment except supportive treatment. Long noncoding RNAs (lncRNAs), a class of noncoding RNAs exceeding 200 nucleotides in length, have been shown to play key roles in fundamental cellular processes, and are considered to be potential targets for treatment. Recent research indicates that lncRNA is involved in the pathogenesis of DNP. Certain overexpressed lncRNAs can enhance the purinergic receptor-mediated neuropathic pain in peripheral ganglia and inflammatory cytokines are released due to receptors activated by adenosine triphosphate. In recent years, our laboratory also has been exploring the relationship and pathogenesis between lncRNAs and DNP. In this review, we focus on the recent progress in functional lncRNAs associated with DNP and investigate their roles related to respective receptors.
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Affiliation(s)
- Xinlu Ren
- Queen Mary University of London Joint Programme, Nanchang University, Nanchang, Jiangxi, China
| | - Runan Yang
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
| | - Lin Li
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
| | - Xiumei Xu
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
| | - Shangdong Liang
- Neuropharmacology Laboratory of Physiology Department, Basic Medical School of Nanchang University, Nanchang, Jiangxi, 330006, China.,Jiangxi Provincial Key Laboratory of Autonomic Nervous Function and Disease, Nanchang, Jiangxi, 330006, China
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