Peripheral neuropathy primary prevention
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Mohamadmostafa Jahansouz M.D.[2]
Overview
The cornerstone of pharmacologic interventions to prevent complications of diabetic peripheral neuropathy is medications and strategies that improve glucose control. Other pharmacologic interventions that address comorbid conditions in patients with diabetes are statins and antihypertensives. These agents may also contribute to preventing diabetic peripheral neuropathy complications, since co-existing peripheral vascular disease can contribute to long-term diabetic complications, such as [[foot ulcerations. Although diabetic peripheral neuropathy is not an outcome in studies addressing these comorbid conditions, they may be described as important comorbidities in studies of glucose control that report on diabetic neuropathy outcomes. Nonpharmacologic treatment options to prevent complications which include: Non-pharmacologic glucose control interventions, such as diet and exercise, interventions to prevent specific complications, Foot care for prevention of foot ulcers and Exercise and balance training for the prevention of falls. A variety of pharmacological approaches has been evaluated to reduce pain and improve health-related quality of life through a number of mechanisms. These include drugs with direct impact on neurotransmitters and inhibitory pathways or drugs that bind to opioid receptors. Several medications are Food And Drug Administration ( FDA) approved for diabetic peripheral neuropathy (e.g., pregabalin) or other types of neuropathy (e.g., gabapentin, lidocaine patches for herpes zoster), but most are approved for other indications (e.g., depression, seizure disorders) and evaluated and used off-label for painful diabetic peripheral neuropathy. For diabetic peripheral neuropathy, pain is the most commonly studied symptom in the literature, although other symptoms, such as paresthesia, that are less commonly addressed in trials are also important to patients. These interventions also focus mainly on treating pain. Although there is less evidence in this area, modalities that have been evaluated specifically for diabetic peripheral neuropathy and addressed in previous, reviews include acupuncture, physical therapy and exercise, electrical stimulation, and surgical decompression. For pharmacologic and lifestyle interventions, prior reviews have mainly addressed medications for glucose control [which have been evaluated in multiple reviews, including recent and ongoing Evidence-based Practice Center (EPC) reviews on oral diabetes medications which have generally not evaluated neuropathy as an outcome, lifestyle interventions, and a variety of quality improvement strategies (such as care management) previously included in the EPC review closing the quality gap series. For nonpharmacologic interventions, some systematic reviews have addressed specific interventions, such as exercise training or improving footwear. The International Working Group on the Diabetic Foot (IWGDF) conducted a systematic review to investigate the effectiveness of interventions (i.e., care intervention, self-management intervention, medical intervention) to prevent first and recurrent foot ulcers or amputation in persons with diabetes who are at-risk for complications. This review found moderate evidence supporting the home-monitoring of foot skin temperatures with subsequent preventative actions and the use of therapeutic footwear with a demonstrated pressure-relieving effect consistently worn by the patient. There was some evidence to suggest that prevention of a recurrent foot ulcer by integrated foot care is effective. Surgical interventions can be effective in selected patients, but the evidence is limited. A variety of pharmacological and non-pharmacological approaches have been evaluated for preventing complications of diabetic peripheral neuropathy. However, complications other than foot ulcers and amputations have not been comprehensively addressed in recent reviews or guidelines.
Primary Prevention
Main sterategies to prevent peripheral bneuropathy include:[1][2][3][4]
- Pharmacologic treatment options to prevent complications:
- The cornerstone of pharmacologic interventions to prevent complications of diabetic peripheral neuropathy is medications and strategies that improve glucose control.
- Other pharmacologic interventions that address comorbid conditions in patients with diabetes are statins and antihypertensives.
- These agents may also contribute to preventing diabetic peripheral neuropathy complications, since co-existing peripheral vascular disease can contribute to long-term diabetic complications, such as [[foot ulcerations. Although diabetic peripheral neuropathy is not an outcome in studies addressing these comorbid conditions, they may be described as important comorbidities in studies of glucose control that report on diabetic neuropathy outcomes.
- Nonpharmacologic treatment options to prevent complications:
- These interventions include:
- Non-pharmacologic glucose control interventions, such as diet and exercise
- Interventions to prevent specific complications, such as:
- Foot care for prevention of foot ulcers
- Exercise and balance training for the prevention of falls
- These interventions include:
- Pharmacologic treatment options to improve symptoms:
- A variety of pharmacological approaches has been evaluated to reduce pain and improve health-related quality of life through a number of mechanisms. These include drugs with direct impact on neurotransmitters and inhibitory pathways or drugs that bind to opioid receptors.
- Several medications are Food And Drug Administration ( FDA) approved for diabetic peripheral neuropathy (e.g., pregabalin) or other types of neuropathy (e.g., gabapentin, lidocaine patches for herpes zoster), but most are approved for other indications (e.g., depression, seizure disorders) and evaluated and used off-label for painful diabetic peripheral neuropathy.
- For diabetic peripheral neuropathy, pain is the most commonly studied symptom in the literature, although other symptoms, such as paresthesia, that are less commonly addressed in trials are also important to patients.
- Nonpharmacologic treatment options To improve symptoms:
- These interventions also focus mainly on treating pain. Although there is less evidence in this area, modalities that have been evaluated specifically for diabetic peripheral neuropathy and addressed in previous, reviews include acupuncture, physical therapy and exercise, electrical stimulation, and surgical decompression.
- Prevention of Complications (Foot Ulcers, Falls, and Perceived Fall Risk:
- For pharmacologic and lifestyle interventions, prior reviews have mainly addressed medications for glucose control [which have been evaluated in multiple reviews, including recent and ongoing Evidence-based Practice Center (EPC) reviews on oral diabetes medications which have generally not evaluated neuropathy as an outcome, lifestyle interventions, and a variety of quality improvement strategies (such as care management) previously included in the EPC review closing the quality gap series.
- For nonpharmacologic interventions, some systematic reviews have addressed specific interventions, such as exercise training or improving footwear. The International Working Group on the Diabetic Foot (IWGDF) conducted a systematic review to investigate the effectiveness of interventions (i.e., care intervention, self-management intervention, medical intervention) to prevent first and recurrent foot ulcers or amputation in persons with diabetes who are at-risk for complications. This review found moderate evidence supporting the home-monitoring of foot skin temperatures with subsequent preventative actions and the use of therapeutic footwear with a demonstrated pressure-relieving effect consistently worn by the patient. There was some evidence to suggest that prevention of a recurrent foot ulcer by integrated foot care is effective. Surgical interventions can be effective in selected patients, but the evidence is limited.
- A variety of pharmacological and non-pharmacological approaches have been evaluated for preventing complications of diabetic peripheral neuropathy. However, complications other than foot ulcers and amputations have not been comprehensively addressed in recent reviews or guidelines.
References
- ↑ Brannagan TH (2012). "Current issues in peripheral neuropathy". J Peripher Nerv Syst. 17 Suppl 2: 1–3. doi:10.1111/j.1529-8027.2012.00387.x. PMID 22548615.
- ↑ Piccolo J, Kolesar JM (2014). "Prevention and treatment of chemotherapy-induced peripheral neuropathy". Am J Health Syst Pharm. 71 (1): 19–25. doi:10.2146/ajhp130126. PMID 24352178.
- ↑ Schloss J, Colosimo M, Vitetta L (2016). "New Insights into Potential Prevention and Management Options for Chemotherapy-Induced Peripheral Neuropathy". Asia Pac J Oncol Nurs. 3 (1): 73–85. doi:10.4103/2347-5625.170977. PMC 5123533. PMID 27981142.
- ↑ Krukowski K, Nijboer CH, Huo X, Kavelaars A, Heijnen CJ (2015). "Prevention of chemotherapy-induced peripheral neuropathy by the small-molecule inhibitor pifithrin-μ". Pain. 156 (11): 2184–92. doi:10.1097/j.pain.0000000000000290. PMC 4900465. PMID 26473292.