Chronic Pain Update 2013: New Data and Perspectives - Episode 9

Effects of Untreated Painful Diabetic Peripheral Neuropathy

In this video clip, the panelists touch on the effects of what they agree to term untreated painful diabetic peripheral neuropathy (PDPN) on a patient’s quality of life.

“When you lose your proprioception, there are decreased tactile stimulation, and you bump into something and you don’t realize that you just cut your toe open. Think of how that manifests itself,” Joseph Pergolizzi, MD, explains. “There are some real issues related to quality of life and functionality, so I think it’s a combination of quality of life and how functionality is greatly impaired for these patients.”

To mitigate the early development of the neuropathic pain syndrome, Pergolizzi and Christopher Gharibo, MD, both suggest a cardiovascular evaluation of lipid levels and blood pressure control, though Gharibo says “good diabetic control is what it comes down to.”

Putting the “500-pound gorilla on the table,” moderator Peter Salgo, MD, asks the panelists whether tight glycemic control in diabetes patients can actually delay the onset of PDPN, to which Jeffrey A. Gudin, MD, answers “not at all.” However, Pergolizzi notes “there’s evidence that leads us to believe that’s true from the neurophysiologic standpoint.”

“We’re doing a better job at keeping people (with type 1 or type 2 diabetes) alive, and this is one of the unfortunate sequelae when they don’t have the best glycemic control,” Pergolizzi says. “With older populations, with advances in medical care, with people surviving cancer, there are other neuropathic conditions like chemotherapy-induced neuropathies, which are again in the sort of same wheelhouse. So we really need to, for the diabetic patient, treat them in a multidisciplinary manner.”