Mechanisms and management of diabetic painful distal symmetrical polyneuropathy.
Mechanisms and management of diabetic painful distal symmetrical polyneuropathy.
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DOI：
10.2337/dc12-1964
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发表时间：
2013-09
期刊：
影响因子：
16.2
通讯作者：
Dickenson AH
中科院分区：
文献类型：
--
作者：
Tesfaye S;Boulton AJ;Dickenson AH
虽然一些糖尿病神经病变可能会导致痛苦的症状，但这篇综述主要集中在最常见的：慢性感觉运动性远端对称性多发性神经病(DSPN)。据估计，15-20%的糖尿病患者可能有痛性DSPN，但并不是所有这些患者都需要治疗。在实践中，DSPN的诊断是一种临床诊断，而对于纵向研究和临床试验，定量感觉测试和电生理评估通常是必要的。有许多简单的数字分级标准可用于评估神经病理性疼痛的频率和严重程度。尽管导致糖尿病神经病理性疼痛的确切病理生理过程仍然是个谜，但外周和中枢机制都已被涉及，并从周围神经通道功能的改变延伸到脊髓加工的增强和许多高级中枢的变化。许多药物已被证明对疼痛的DSPN有效，但都容易产生副作用，而且由于它们只是对症治疗，因此没有一种药物会影响潜在的病理生理异常。监管部门批准的两种治疗痛性神经病的一线疗法是度洛西汀和普瑞巴林。α-硫辛酸是一种抗氧化剂和致病疗法，有证据表明它有效，但在美国和几个欧洲国家尚未获得许可。所有患有DSPN的患者都有更高的足部溃疡风险，需要足部护理、教育，如果可能的话，还需要定期进行足部评估。
Although a number of the diabetic neuropathies may result in painful symptomatology, this review focuses on the most common: chronic sensorimotor distal symmetrical polyneuropathy (DSPN). It is estimated that 15–20% of diabetic patients may have painful DSPN, but not all of these will require therapy. In practice, the diagnosis of DSPN is a clinical one, whereas for longitudinal studies and clinical trials, quantitative sensory testing and electrophysiological assessment are usually necessary. A number of simple numeric rating scales are available to assess the frequency and severity of neuropathic pain. Although the exact pathophysiological processes that result in diabetic neuropathic pain remain enigmatic, both peripheral and central mechanisms have been implicated, and extend from altered channel function in peripheral nerve through enhanced spinal processing and changes in many higher centers. A number of pharmacological agents have proven efficacy in painful DSPN, but all are prone to side effects, and none impact the underlying pathophysiological abnormalities because they are only symptomatic therapy. The two first-line therapies approved by regulatory authorities for painful neuropathy are duloxetine and pregabalin. α-Lipoic acid, an antioxidant and pathogenic therapy, has evidence of efficacy but is not licensed in the U.S. and several European countries. All patients with DSPN are at increased risk of foot ulceration and require foot care, education, and if possible, regular podiatry assessment.
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影响因子：
3.7
作者：
Binder A;May D;Baron R;Maier C;Tölle TR;Treede RD;Berthele A;Faltraco F;Flor H;Gierthmühlen J;Haenisch S;Huge V;Magerl W;Maihöfner C;Richter H;Rolke R;Scherens A;Uçeyler N;Ufer M;Wasner G;Zhu J;Cascorbi I
通讯作者：
Cascorbi I
影响因子：
5
作者：
Blackburn-Munro, G;Jensen, BS
通讯作者：
Jensen, BS
影响因子：
7.4
作者：
Bee, Lucy A.;Bannister, Kirsty;Dickenson, Anthony H.
通讯作者：
Dickenson, Anthony H.
影响因子：
5.1
作者：
Attal, N.;Cruccu, G.;Nurmikko, T.
通讯作者：
Nurmikko, T.
影响因子：
5.1
作者：
BOULTON, AJM;SCARPELLO, JHB;WARD, JD
通讯作者：
WARD, JD