Cytokine inhibitors and nonsteroidal anti-inflammatory drugs are being explored for their potential to alleviate neuropathic pain. Depletion of macrophages or inhibition of their migration improves mechanical sensation and nerve function in animal models. 295 296 cytokine inhibitors and nonsteroidal anti-inflammatory drugs are being studied for their potential to alleviate neuropathic pain, 83 284 immunomodulatory therapies aimed at specific components of the immune response offer promising ways to reduce nerve inflammation and promote repair (fig. Some emerging non-pharmacological interventions for DPN include neuromodulation technology, such as spinal cord stimulation, which has recently been approved by the Food Administration and Medications (FDA) from the United States for painful diabetic neuropathy.
These devices act directly on the nervous system and are promising as next-generation therapy when traditional therapies fail. Diabetic peripheral neuropathy is a common complication of long-term diabetes mellitus. These neuropathies can occur in a variety of forms and, with the increase in the prevalence of diabetes mellitus, a subsequent increase in cases of peripheral neuropathy has been observed. Peripheral neuropathy poses a significant social and economic burden, as patients need concomitant medication and often experience a decline in their quality of life.
There are currently a wide variety of pharmacological interventions, including serotonin and noradrenaline reuptake inhibitors, gapentanoids, sodium channel blockers and antidepressants Tricyclics. These medications will be discussed, as well as their respective efficacy. Recent advances in the treatment of diabetes mellitus with drugs that modulate the incretin system, specifically with glucagon-like peptide-1 agonists, are promising, and this review discusses their possible involvement in the treatment of diabetic peripheral neuropathy. In addition, injectable therapies may be crucial for directly treating and controlling diabetic neuropathy.
This category encompasses nerve-blocking injections, which consist of injections aimed at specific nerves, which provide temporary relief from severe pain. In addition, stem cell therapy is emerging as a possible treatment route, with the goal of regenerating damaged nerves and offering long-term relief. These therapeutic options contribute to a comprehensive approach to addressing the challenges posed by diabetic neuropathy, with the potential to significantly improve well-being and quality of life. A treatment option recently introduced in Pain Medicine of Evangelical can alleviate pain through capsaicin, commonly known as the active ingredient in chili peppers.
Qutenza (capsaicin) 8% is a topical treatment for painful diabetic peripheral neuropathy of the feet. Maintaining good glycemic control helps prevent the development of neuropathy in patients with type 1 diabetes, although the effect is less pronounced in those with type 2 diabetes. Compared to placebo, the recipients of the topical system with capsaicin at 8% had a shorter median response time to treatment (defined as the first of three consecutive days in which the patient reported a ≥ 30% decrease from baseline in the average daily pain score; 19 versus 72 days), modest improvements from baseline in sleep interference scores during weeks 2 to 8 and 2 to 12 weeks (p ≤ 0.03 compared to placebo) and there was no change in perception tests sensory and reflexes. Spinal cord stimulation also emerges as a pioneering method in the field of pain treatment in diabetic neuropathy.
The ACE inhibitor or angiotensin II receptor antagonist attenuates diabetic neuropathy in diabetic rats induced by streptozotocin. Collaborative care models improve lifestyle interventions by focusing on diet, exercise and foot care, essential for preventing complications such as diabetic foot ulcers. While the increases in vasodilation and improvements in sensory heat perception tests seen with the 8% capsaicin topical system require more research, they may indicate the restoration of sensory function, which, in turn, may improve the overall health of the diabetic foot. Painful diabetic neuropathy is associated with greater autonomic dysfunction than painless diabetic neuropathy.
Minimizing side effects and optimizing treatment benefits requires close monitoring, patient education, and an individualized approach to drug selection and dosing. The use of these neuromodulatory options requires careful consideration of the patient's individual characteristics (e.g., the location and intensity of pain, the stage of progression of DPN, response to previous pain treatments, comorbid medical conditions and concomitant pharmacological treatment), as well as their advantages and disadvantages from a patient-centered perspective. Machine learning models for the diagnosis of diabetic neuropathy using microcirculatory parameters in patients with type 2 diabetes.
