How to treat painful diabetic peripheral neuropathy
In his second module for our ‘Diabetic neuropathy’ course, Professor Solomon Tesfaye takes a closer look at the pathophysiology of diabetic peripheral neuropathy and surveys the treatments currently available.
There is little doubt in Professor Solomon Tesfaye’s mind as to what causes diabetic peripheral neuropathy. “The cause is impaired blood flow. This is another microvascular complication of diabetes.”
The changes brought about by impaired blood flow are not restricted to ‘peripheral’ nerves – reduction in the intraepidermal nerve fibres, myelinated fibres, etc. “In parallel to these,” says Professor Tesfaye, “there are central nervous system changes. A lot of this work has come from our unit but is now being reproduced by many other units around the world, showing that spinal cord reduction in cord cross-sectional area. There is a reduction in cortical thickness in the somatosensory cortex. There are changes in haemodynamics, in the blood flow of the thalamus and anterior cingulate cortexes in those with painful diabetic neuropathy. There is also cortical reorganisation of the pain-processing areas of the brain and default network abnormalities. Diabetic peripheral neuropathy is not as its name suggests – it actually affects both the peripheral and the central nervous systems.”
This module’s primary focus, however, is on how to go about the treatment and management of patients with often complex and sometimes refractory disease. Taking a scenario-based approach, Professor Tesfaye’s module is an invaluable guide not only to established pharmacotherapy and newer, emerging treatment options, but also to the sort of multidisciplinary team approach required to provide a comprehensive service for people with or at risk of diabetic peripheral neuropathy.
‘Pathophysiology and treatment of painful diabetic neuropathy’ launches today. The launch will be marked by a live presentation and Q&A session with Professor Solomon Tesfaye at the EASD Annual Meeting (14.00-17.30 CET).