Painful Neuropathy Diabetic Foot Society of India糖尿病痛性神经病变的糖尿病足的印度社会课件.pptVIP

Diabetic painful neuropathy Dr. Ashok Kumar Das Diabetic painful neuropathy This is a definite subset of diabetic neuropathy and requires more attention owing to its painful condition, disability and wide spectrum of clinical syndrome Diabetic painful neuropathy Comprises of clinical syndromes like acute painful neuropathy, chronic sensorimotor neuropathy, proximal painful symmetrical motor neuropathy, proximal painful asymmetrical motor neuropathy (diabetic amyotrophy) painful diabetic external ophthalmoplegia, treatment induced insulin neuritis, hypoglycaemic neuritis and painful painless leg . Diabetic painful neuropathy * Pain is a feature of small fiber neuropathy. The small fibers also carry autonomic impulses. * It seems logical to expect increased incidence of autonomic denervation in painful diabetic neuropathies Diabetic painful neuropathy Relief of pain is of paramount importance and obligatory on the part of physician. But the state of the art of pain relief in this syndrome is far from satisfactory. Many modalities of treatment have been advocated but the arena of therapy is full of claims and counter claims. Diabetic painful neuropathy * These modalities range from simple analgesic to most modern aldolase reductase inhibitors * In the national context, pain relief must be obtained by simple measures Clinical types of painful diabetic neuropathy - 1 Although a rigid classification of painful diabetic neuropathy is very difficult they may be grouped under following three major categories 1. Symmetrical distal painful poly- neuropathies 2. Proximal motor neuropathies 3. Focal asymmetrical painful neuropathies Clinical types of painful diabetic neuropathy - 2 Symmetrical distal painful polineuropathies may be grouped as 1. Small fibre type 2. Mixed large and small fibre type 3. Hypoglycaemic neuropathy/insulin neuritis 4. Mixed distal sensory-motor neuropathy Clinical types of painful diabetic neuropathy - 3 Proximal m