An integrated perspective on diabetic, alcoholic, and drug-induced neuropathy, etiology, and treatment in the US

Abstract

Neuropathic pain (NeuP) is a syndrome that results from damaged nerves and/or aberrant regeneration. Common etiologies of neuropathy include chronic illnesses and medication use. Chronic disorders, such as diabetes and alcoholism, can cause neuronal injury and consequently NeuP. Certain medications with antineoplastic effects also carry an exquisitely high risk for neuropathy. These culprits are a few of many that are fueling the NeuP epidemic, which currently affects 7%–10% of the population. It has been estimated that approximately 10% and 7% of US adults carry a diagnosis of diabetes and alcohol disorder, respectively. Despite its pervasiveness, many physicians are unfamiliar with adequate treatment of NeuP, partly due to the few reviews that are available that have integrated basic science and clinical practice. In light of the recent Centers for Disease Control and Prevention guidelines that advise against the routine use of μ-opioid receptor-selective opioids for chronic pain management, such a review is timely. Here, we provide a succinct overview of the etiology and treatment options of diabetic and alcohol- and drug-induced neuropathy, three different and prevalent neuropathies fusing the combined clinical and preclinical pharmacological expertise in NeuP of the authors. We discuss the anatomy of pain and pain transmission, with special attention to key ion channels, receptors, and neurotransmitters. An understanding of pain neurophysiology will lead to a better understanding of the rationale for the effectiveness of current treatment options, and may lead to better diagnostic tools to help distinguish types of neuropathy. We close with a discussion of ongoing research efforts to develop additional treatments for NeuP.

Cannabis for peripheral neuropathy: The good, the bad, and the unknown

“…Many patients experience emotional, cognitive, and functional problems, resulting in high rates of medical and psychiatric comorbidities and occupational impairment. 4,6,7 Yet despite its clinical and epidemiologic signifi cance, it is often undertreated. 8…”

Neurological Complications of Diabetes Mellitus

“…Самое частое неврологическое осложнение сахарного диабета со стороны периферической нервной системы -дистальная симметричная сенсорно-моторная полиневропатия, поражающая примерно 50% пациентов с СД обоих типов. Диагноз диабетической полиневропатии (ДПН) предполагает наличие симптомов или признаков дисфункции периферических нервов у пациентов с СД после исключения других возможных причин поражения периферических нервов [27]. Распространенность ДПН варьируется от 50% при клиническом обследовании до 90-100% при проведении более информативного электронейромиографического обследования у пациентов с длительностью сахарного диабета более 20 лет [28,29].…”

Lens autofluorescence ratio as a noninvasive marker of peripheral diabetic neuropathy

“…1 Diabetic neuropathy is the most common complication of diabetes mellitus and affects as many as 50% of patients. 2,3 Diabetic peripheral neuropathy (DPN) accounts for approximately 75% of diabetic neuropathy cases and is the primary risk factor for diabetic foot ulceration and amputation. 4,5 Several different methods can be used to detect DPN, including clinical findings and quantitative methods (eg, nerve conduction studies, validated questionnaires, vibration sense,…”