Continuum : lifelong learning in neurology
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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.
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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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Continuum (Minneap Minn) · Feb 2012
Case ReportsDifficult decisions: managing chronic neuropathic pain with opioids.
The decision to use opioids to treat chronic neuropathic pain is complex and somewhat controversial. Although opioid therapy may be appropriate for some patients with chronic neuropathic pain, physicians must implement strategies to reduce opioid abuse, addiction, and diversion. ⋯ Fortunately, specific recommendations for the safe and effective use of opioids are now available in several recently published guidelines. The best practices embodied in these guidelines should be considered for widespread adoption by both individual providers and health care systems.