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Author: Grafiati
Published: 11 September 2023

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1

Boulton, Andrew J. M., and Loretta Vileikyte. Managing Neuropathic Pain in the Diabetic Patient. Tarporley: Springer Healthcare Ltd., 2009. http://dx.doi.org/10.1007/978-1-908517-16-6.

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2

Galer, Bradley S. Defeat chronic pain now: Groundbreaking strategies for eliminating the pain of arthritis, back and neck conditions, migraines, diabetic neuropathy, and chronic illness. Beverly, MA: Fair Winds Press, 2010.

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3

Galer, Bradley S. Defeat chronic pain now!: Groundbreaking strategies for eliminating the pain of arthritis, back and neck conditions, migraines, diabetic neuropathy, and chronic illness. Beverly, MA: Fair Winds Press, 2010.

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4

Galer, Bradley S. Defeat chronic pain now: Groundbreaking strategies for eliminating the pain of arthritis, back and neck conditions, migraines, diabetic neuropathy, and chronic illness. Beverly, MA: Fair Winds Press, 2010.

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5

Nageshwaran, Sathiji, Heather C. Wilson, Anthony Dickenson, and David Ledingham. Neuropathic pain. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780199664368.003.0005.

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This chapter on neuropathic pain discusses the classification, clinical features, and evidence-based management of major neuropathic pain syndromes (painful polyneuropathy, diabetic neuropathy, post-herpetic neuralgia, HIV neuropathy, cancer neuropathic pain, phantom pain, traumatic neuropathic pain, chronic radiculopathy, central neuropathic pain, and trigeminal neuralgia).
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6

Khursheed, Faraz, and Marc O. Maybauer. Neuropathic Pain. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190271787.003.0012.

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Neuropathic pain is a common condition that arises from injury anywhere along the somatosensory axis. Although the presentation may vary based on mechanisms and locations of injury, most patients have characteristic burning, shocklike, lancinating pain, most often in the distribution of peripheral and spinal nerves or distal extremities. Various peripheral and central processes aggravate pain through abnormal impulse generation, modulation, and processing. Common conditions include complex regional pain syndrome, diabetic neuropathy, postherpetic neuralgia, spondylotic radiculopathy, and central pain syndromes. A detailed history and physical examination will aid in differentiating various neuropathic pain conditions. Neuropathic pain is best managed using a true multidisciplinary approach.
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7

Boulton, Andrew Jm, and Loretta Vileikyte. Managing Neuropathic Pain in the Diabetic Patient. Springer, 2012.

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8

Vileikyte, Loretta, and Andrew JM Boulton. Managing Neuropathic Pain in the Diabetic Patient. Springer Healthcare, 2011.

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9

Shaibani, Aziz. Numbness. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0023.

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Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is hard to capture them via video unless they have a very specific pattern and they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. It follows gloves and stocks distribution. Sensory neuropathies may present with ataxia which results in falls, or severe pain. Neuropathic pain with normal ankle reflexes and sural responses suggest small fiber neuropathy. Multifocal sensory loss is usually vascular. It can also be infectious (leprosy). Migratory neuritis is a poorly understood condition. Intercostal pain and numbness is usually due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Foots ulcers and unfelt mosquito bites are markers for sensory loss. Loss of corneal sensation may led to keratitis and blindness.
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10

Shaibani, Aziz. Numbness. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0023.

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Sensory symptoms are the most common symptoms in neuromuscular clinics, yet it is difficult to capture them in videos unless they have a very specific pattern and/or they are associated with objective loss of sensation. Distal sensory loss is a common neuropathic finding. Sensory neuropathies may also present with ataxia or severe pain. Multifocal sensory loss is usually vascular (vasculitis, diabetic amyotrophy). Intercostal pain and numbness are due to radiculopathy (diabetic, zoster, or compressive radiculopathy). Thoracic and abdominal radiculopathies are often misdiagnoses as acute coronary or abdominal emergencies respectively. The distribution of pain and the associated tingling and skin sensitivity to touch are important clues to their neuropathic nature.
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11

Cornblath, David R., and Richard A. C. Hughes. Peripheral neuropathy. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199658602.003.0013.

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Disorders of peripheral nerves are one of the most common neurological problems today and include the increasing number of people with diabetes worldwide and those with inherited neuropathy, toxic neuropathy, carpal tunnel syndrome, inflammatory neuropathy, radiculopathies, and, increasingly, traumatic nerve injuries. Neuropathic pain is a growing problem without solution. In this chapter, ten landmark papers in peripheral nerve disorders have been selected, covering Bell’s palsy, Charcot-Marie-Tooth disease, carpal tunnel syndrome, paraneoplastic neuropathy, neurophysiology, familial amyloid polyneuropathy, chronic inflammatory demyelinating polyradiculoneuropathy, toxic neuropathy, diabetic neuropathy, and Guillain–Barré syndrome. These important papers set the stage for many subsequent advances in the field but may be forgotten now, so they are brought to the reader’s attention.
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12

Serpell, Mick G. Antineuropathic medication combination therapy. Edited by Paul Farquhar-Smith, Pierre Beaulieu, and Sian Jagger. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198834359.003.0068.

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The landmark paper discussed in this chapter is ‘Morphine, gabapentin, or their combination for neuropathic pain’, published by Gilron et al. in 2005. Although combination drug therapies for neuropathic pain had long been suggested, this seminal paper provided the first evidence for efficacy of combination therapy of mechanistically distinct medications in analgesia, using morphine in combination with gabapentin in post-herpetic neuralgia or diabetic neuropathy. Combination therapy had greater efficacy than gabapentin alone and was equally effective as morphine alone but with a lower dose of morphine; however, this did not seem to translate into reduced side effects. To this day, precious little is known about what are the most effective combinations for neuropathic pain, and the need for large randomized controlled trials in this area is still as pressing it was back in 2005.
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13

Cavanna, Andrea E. Gabapentin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0006.

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Gabapentin is a second-generation antiepileptic drug characterized by few antiepileptic indications, with very good interaction profile in polytherapy. The therapeutic indications of gabapentin for the treatment of epileptic seizures have been largely overshadowed by its widespread use for the treatment of neuropathic pain (especially post-herpetic neuralgia, diabetic neuropathy, and pain caused by a spinal cord injury). Gabapentin has a good behavioural tolerability profile and a good range of psychiatric uses (unlicensed indications for anxiety disorders and alcohol withdrawal symptoms). Despite the widespread use of gabapentin for behavioural conditions, its potential usefulness as adjunctive treatment of bipolar affective disorder is still controversial.
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14

Cavanna, Andrea E. Pregabalin. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198791577.003.0011.

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Pregabalin is a second-generation antiepileptic drug characterized by few antiepileptic indications, with a very good interaction profile in polytherapy. The therapeutic indications of pregabalin for the treatment of epileptic seizures have been largely overshadowed by its widespread use for the treatment of anxiety disorders (especially generalized anxiety disorder and social anxiety disorder) and neuropathic pain (especially post-herpetic neuralgia, diabetic neuropathy, and pain caused by a spinal cord injury). Pregabalin has a very good behavioural tolerability profile and a wide range of psychiatric uses. Specifically, it has a licensed indication for generalized anxiety disorder for which it is currently widely prescribed.
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15

Barthel, Andreas, and Michael Bauer. Psychotropic drugs and metabolic risk. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780198789284.003.0011.

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Increased appetite and weight gain represent a significant problem related with particular antipsychotic drugs, antidepressants, mood stabilizers, and—to a lesser extent—anxiolytic drugs. Psychotropic drug-induced weight gain may contribute to obesity-related metabolic changes and pathological conditions such as dyslipidaemia, type-2-diabetes and hypertension—summarized as the metabolic syndrome—with an increased risk for cardiovascular morbidity and mortality. Interestingly, psychotropic drugs are also used for the treatment of diabetes-related complications. For example, antidepressants are effective for the treatment of neuropathic pain in patients with diabetic neuropathy. Therefore, it is essential to thoroughly balance potential benefits and risks in an individual patient to ensure drug safety and optimize the clinical outcome. In addition to diet and exercise, selection of psychotropic drugs and dose adjustment based on regular clinical follow-up visits is the key for the prevention and management of psychotropic drug induced weight gain in clinical practice.
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16

Katirji, Bashar. Case 7. Edited by Bashar Katirji. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190603434.003.0011.

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Diabetic amyotrophy is a relatively uncommon neurological complication of diabetes mellitus. However, the disorder is often not recognized by internists and neurologists and misdiagnosed as myopathy, radiculopathy, or peripheral polyneuropathy. The discussion starts by outlining the classification of the diabetic neuropathies. This case highlights the classical clinical presentation of diabetic amyotrophy, also referred to as diabetic polyradiculoplexopathy or subacute diabetic neuropathy, in a man with pain in the anterior thigh and knee followed by thigh and hip weakness. It also emphasizes the electrodiagnostic findings including the subacute needle electromyography changes and stresses the frequent coexistence of diabetic amyotrophy with the more common distal peripheral polyneuropathy in the majority of patients.
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17

Murinova, Natalia, and Daniel Krashin. Susceptibility of Peripheral Nerves in Diabetes to Compression and Implications in Pain Treatment. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190626761.003.0006.

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Diabetes affects a large and growing percentage of the population in most countries of the world. Diabetes causes many different health problems, but among the most severe and disabling is peripheral neuropathy. This progressive, often painful nerve condition causes suffering and disability and also predisposes patients to developing musculoskeletal deformities and foot ulcers that may threaten life and limb. This chapter reviews briefly the significance of this condition, the underlying pathophysiology, and surgical considerations. Surgical decompression is a possible treatment for this neuropathy and may help prevent disastrous complications of diabetic peripheral neuropathy. However, foot surgery in the setting of diabetic peripheral neuropathy also carries significant risks.
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18

Shaibani, Aziz. Quadriceps Weakness. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199898152.003.0014.

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Quadriceps muscles extend the knees and are important for walking and balance. Knee buckling is the most common presentation of quadriceps weakness. Knee buckling is common in the elderly as it can also be caused by knee arthritis. Patients with quadriceps weakness often modify their lifestyle for years before they seek medical advice. Quadriceps muscles are very sensitive to immobility and they may lose 50% of their bulk within 2 weeks of immobility. On the other hand, they build mass quickly by exercises. Sometimes, quadriceps muscles are selectively and severely involved, leading to an early disability. Severe thigh pain, if continued for a few weeks, may lead to disuse atrophy. Severe neuropathic thigh pain and atrophy are typically seen in diabetic amyotrophy. Other causes of thigh pain include L3 radiculopathy, meralgia paresthetica, and muscle infarction. Examination of the knee extension should never be deleted from neuromuscular evaluation.
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19

Shaibani, Aziz. Quadriceps Weakness. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190661304.003.0014.

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Quadriceps muscles extend the knees and are important for walking and balance. Knee buckling (sudden giving away of the knees) is the most common presentation of quadriceps weakness. Knee buckling is common in the elderly, as it can also be caused by knee arthritis. Patients with quadriceps weakness often modify their lifestyle for years before they seek medical advice. Quadriceps muscles are very sensitive to immobility, and they may lose half their bulk within 2 weeks. On the other hand, they build mass quickly with exercise. Sometimes quadriceps muscles are selectively and severely involved, leading to early disability. Severe thigh pain, if it continues for a few weeks, may lead to disuse atrophy. Severe neuropathic thigh pain and atrophy are typically seen in diabetic amyotrophy. Other causes of thigh pain include L3 radiculopathy, meralgia paresthetica, and muscle infarction. Examination of the knee extension should always be part of neuromuscular evaluation.
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20

Messina, Kierstyn. Life Without Tingling and Pain: Alleviating Diabetic Neuropathy Symptoms. Oceanside Labs LLC, 2021.

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21

Messina, Kierstyn. Life Without Tingling and Pain: Alleviating Diabetic Neuropathy Symptoms. Oceanside Labs LLC, 2021.

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22

Messina, Kierstyn. Life Without Tingling and Pain: Alleviating Diabetic Neuropathy Symptoms. Oceanside Labs LLC, 2021.

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23

Cohen, Jeffrey A., Justin J. Mowchun, Victoria H. Lawson, and Nathaniel M. Robbins. A 56-Year-Old Woman with Small-Fiber Neuropathy and Progressive Leg Pain and Weakness. Oxford University Press, 2016. http://dx.doi.org/10.1093/med/9780190491901.003.0021.

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The sudden onset of leg weakness and pain may be mistaken for an acute lumbosacral radiculopathy due to a herniated disc. However, in diabetics it is also essential to consider the entity of Bruns-Farland syndrome, or diabetic lumbosacral plexopathy (DLSP). DLSP is uncommon compared with lumbosacral radiculopathy, so delays in diagnosis are the rule rather than the exception. In this chapter we present the clinical characteristics of DLSP and the key features that can help with making a prompt diagnosis. The use of nerve conduction studies and EMG for confirmation of DLSP is reviewed. Treatment options and controversies are discussed.
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24

Donaghy, Michael. Focal peripheral neuropathy. Oxford University Press, 2011. http://dx.doi.org/10.1093/med/9780198569381.003.0487.

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Some causes of focal peripheral nerve damage are self-evident, such as involvement at sites of trauma, tissue necrosis, infiltration by tumour, or damage by radiotherapy. Focal compressive and entrapment neuropathies are particularly valuable to identify in civilian practice, since recovery may follow relief of the compression. Leprosy is a common global cause of focal neuropathy, which involves prominent loss of pain sensation with secondary acromutilation, and requires early antibiotic treatment. Mononeuritis multiplex due to vasculitis requires prompt diagnosis and immunosuppressive treatment to limit the severity and extent of peripheral nerve damage. Various other medical conditions, both inherited and acquired, can present with focal neuropathy rather than polyneuropathy, the most common of which are diabetes mellitus and hereditary liability to pressure palsies. A purely motor focal presentation should raise the question of multifocal motor neuropathy with conduction block, which usually responds well to high-dose intravenous immunoglobulin infusions.
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25

Chiravuri, Srinivas. Lateral Femoral Cutaneous Neuropathy—Meralgia Paresthetica. Edited by Meghan E. Lark, Nasa Fujihara, and Kevin C. Chung. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190617127.003.0014.

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Meralgia paresthetica is characterized by anterolateral thigh pain, paresthesia, or dysesthesia without motor weakness. This is due to idiopathic or iatrogenic injury to the lateral femoral cutaneous nerve (LFCN, dorsal rami of L2-L3). Risk factors include obesity, diabetes, and external compression near the inguinal ligament’s attachment to the anterior superior iliac spine. Diagnosis is based on clinical presentation and electrodiagnostic studies. Initial management includes behavioral modification, physical therapy, and pharmacotherapy. More invasive treatment modalities include LFCN infiltration, pulsed radiofrequency, direct nerve stimulation, and spinal cord stimulation. Ultrasound-guided neurectomy is also an effective way to localize the nerve structure and ensure complete nerve transection.
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