Effectiveness of oral clonidine and gabapentin on peripheral neuropathy in diabetic patients in southwestern Iran: a randomized clinical trial

Application of Continuous Care Pattern Based on Information-Motivation-Behavioral Skills Model in out-of-Hospital Rehabilitation of Diabetic Foot Ulceration Patients: A Randomized Controlled Trial

OBJECTIVE

To explore the effect of information-motivation-behavioral skills model (IMB)-based continuous nursing model on the out-of-hospital rehabilitation of diabetic foot ulceration (DFU) patients, and to provide a theoretical basis for long-term disease management of DFU patients.

METHODS

A total of 88 patients with DFU admitted to our Hospital were included in this prospective study. The patients were divided into control and study groups using the random number table method, with 44 cases in each group. Patients in the study group received both routine care and IMB-based continuing care, and the control group received only routine care.

RESULTS

At week 1, FBS, PBG (2 h) and HbA1c were significantly decreased in the study group compared with that in the control group (P < .05). At week 3 and 6, blood glucose indicators were significantly improved in both groups compared with week 1 (P < .05). In additional, the number of non-infected patients at week 1 and week 3 in the study group was significantly higher than that in the control group (P < .05). At week 3, the number of cured patients was significantly higher in the study group than that in the control group (P < .05). And the area of ulcer healing in the study group was significantly larger than that in the control group at week 1 and week 3 (P < .05).

CONCLUSION

In conclusion, the continuous nursing mode based on IMB can help DFU patients manage blood glucose level, reduce wound infection, and accelerate wound healing, which is worthy of wide clinical application and promotion.

Novel drug treatments for pain in advanced cancer and serious illness: a focus on neuropathic pain and chemotherapy-induced peripheral neuropathy

Drugs that are commercially available but have novel mechanisms of action should be explored as analgesics. This review will discuss haloperidol, miragabalin, palmitoylethanolamide (PEA), and clonidine as adjuvant analgesics or analgesics. Haloperidol is a sigma-1 receptor antagonist. Under stress and neuropathic injury, sigma-1 receptors act as a chaperone protein, which downmodulates opioid receptor activities and opens several ion channels. Clinically, there is only low-grade evidence that haloperidol improves pain when combined with morphine, methadone, or tramadol in patients who have cancer, pain from fibrosis, radiation necrosis, or neuropathic pain. Miragabalin is a gabapentinoid approved for the treatment of neuropathic pain in Japan since 2019. In randomized trials, patients with diabetic neuropathy have responded to miragabalin. Its long binding half-life on the calcium channel subunit may provide an advantage over other gabapentinoids. PEA belongs to a group of endogenous bioactive lipids called ALIAmides (autocoid local injury antagonist amides), which have a sense role in modulating numerous biological processes in particular non-neuronal neuroinflammatory responses to neuropathic injury and systemic inflammation. Multiple randomized trials and meta-analyses have demonstrated PEA's effectiveness in reducing pain severity arising from diverse pain phenotypes. Clonidine is an alpha2 adrenoceptor agonist and an imidazoline2 receptor agonist, which is U.S. Federal Drug Administration approved for attention deficit hyperactivity disorder in children, Tourette's syndrome, adjunctive therapy for cancer-related pain, and hypertension. Clonidine activation at alpha2 adrenoceptors causes downstream activation of inhibitory G-proteins (Gi/Go), which inhibits cyclic Adenosine monophosphate (AMP) production and hyperpolarizes neuron membranes, thus reducing allodynia. Intravenous clonidine has been used in terminally ill patients with poorly controlled symptoms, in particular pain and agitation.