Continuum : lifelong learning in neurology
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Continuum (Minneap Minn) · Feb 2012
Case ReportsGuidelines in practice: treatment of painful diabetic neuropathy.
This article describes a patient with a painful diabetic peripheral neuropathy. Features of his history, examination, and diagnostic workup are presented. His treatment course is described as guided by the AAN's evidence-based guideline on the treatment of painful diabetic neuropathy. Lastly, features of coding for diabetic peripheral neuropathy are reviewed.
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Continuum (Minneap Minn) · Feb 2012
Case ReportsOpioid administration for severe neuropathic pain in a patient with depression and prior heroin use.
The treatment of pain can raise ethical dilemmas. This article presents a case of a young woman with a pain crisis from severe neuropathic pain that is complicated by comorbidities of depression and prior (but not active) heroin use. Medical and ethical justifications for either withholding or providing opioids for her pain are examined. State and federal laws governing opioid prescriptions by physicians for pain management are reviewed.
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Diabetes is the most common cause of peripheral neuropathy in the world. More than half of patients with diabetes have neuropathy, and half of patients with neuropathy have diabetes. Diabetic neuropathy is a major cause of disability and health care expense. This article reviews the various forms of diabetic neuropathy with a focus on diagnosis and treatment. ⋯ While disease-altering therapy continues to prove elusive, our understanding of basic disease mechanisms is improving, and new diagnostic and research tools will hopefully lead to novel therapies for distal symmetric diabetic polyneuropathy.
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Continuum (Minneap Minn) · Feb 2012
Review Case ReportsNeuropathic pain: mechanisms, therapeutic approach, and interpretation of clinical trials.
Neuropathic pain (NP) is caused by a lesion of the somatosensory system and is characterized by a combination of positive symptoms (ongoing pain, paroxysmal pain, evoked pain) and negative phenomena (sensory deficit in the painful area). Examples of NP include painful diabetic and nondiabetic neuropathies, postherpetic neuralgia, traumatic nerve lesions, radiculopathies, and central pain (eg, spinal cord injury pain, poststroke pain). This review presents the mechanisms and therapeutic options for NP. ⋯ The management of patients with chronic NP is challenging because of the multiplicity of mechanisms involved in NP conditions. Evidence-based recommendations for the pharmacologic treatment of NP have recently been proposed.
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This article reviews the clinical features, pathophysiology, and treatment of small fiber sensory neuropathy. ⋯ Neuropathic pain from small fiber neuropathy is prevalent and is caused by a wide variety of disorders, many of which are treatable, especially if recognized early in the process.