Escolar Documentos
Profissional Documentos
Cultura Documentos
Boulton AJM, Gries FA, Jervell JA: Guidelines for the diagnosis and outpatient
management of diabetic peripheral neuropathy. Diabetic Med 15:508–514, 1998
HISTORY
1550 BC: First report of diabetes (disease with polyuric state), written in
hieroglyphs, found in a grave in thebes by Egyptologist, Ebers. Treated with
decoction of bones, wheat, grain, grit, green lead and earth.
2nd century AD Areteaus used term “dia” ( to pass through), “betes” ( a water
tube) for kidney disease
5th century AD Chen Chuan in china noticed polyuria and sweet-tasting urine.
Recommended abstinence from wine, salt and sex
Sushruta in India also noted that the urine of diabetics tastes “like honey”. He
also seemed to describe for the first time, the symptoms of
neuropathy…burning in the palms and soles.
HISTORY
Most of initial reports from the Orient.
Episodic symptoms:
Diabetic neuropathic cachexia (DNC)
Hyperglycemic neuropathy
Treatment-induced diabetic neuropathy
PATHOGENESIS
.
Duloxetine
Adverse events (largely dose-dependent)
Nausea, somnolence, dizziness, constipation, dry mouth
Drug interactions
MAOIs (wait 14 days)
TCAs, Phenothiazines, Type 1C antiarrhythmics, Quinolone
antibiotics and Cimetidine
Precautions: closed-angle glaucoma and hepatotoxicity
Black box warnings: suicide risk
GABAPENTIN: DPN
RCT 8 wk in 165 DPN patients GBP vs PBO:
Mean daily pain scores lower in GBP group (p<.001)
26% pain-free vs. 15% on placebo at 8 wks
Improved quality of life & sleep
JAMA 1998;280:1831-36
* Differences NS
Int J Neurosci. 2011;121:521-7
OPIOD: TRAMADOL IN DPN
• Centrally-acting:
̶ Binds μ-opioid receptors
̶ Weak inhibitor of NEP/5HT reuptake
• RCT tramadol (n=65; 50-400 mg) vs.
PBO (n= 66):
̶ Effective in DPN
̶ Mean dose 210 mg/d
̶ No effect on sleep
̶ AEs: nausea, constipation,
HA & somnolence
Neurology 1998;50:1842
ANALGESICS/ OPIOD: Oxycodone CR
• RCT n=159
• Dose 10 mg BID increased Q 3 d to maximum 60
mg BID
• Primary efficacy was pain intensity at days 28 & 42
• Results at mean dose of 37 mg/d (10-100):
̶ Effective in moderate to severe DPN pain
̶ Adverse events in 96% vs. 68% on PBO
• Constipation 42%
• Somnolence 40%
• Nausea 36%
• Dizziness 32%
Vertex study:
Nav 1.8 blocker , for small fiber neuropathy
A Phase 2, Randomized, Double-blind, Placebo-controlled, Study of the
Efficacy and Safety of VX-150
Dose 1250mg daily oral dose
Primary end point: Change from baseline in the weekly average of daily pain
intensity on the 11-point numeric rating scale (NRS), as reported in the
daily diary, at Week 6
Thank You
KU NM NEUROPATHY TEAM