Neuropathic Pain in Type 2 Diabetes Mellitus Patients

第二型糖尿病患之神經性疼痛

曹心怡(Shin-Yi Tsao) ； 徐惠娟(Hui-Chuan Hsu) ； 劉志中(Chih-Chung Liu) ； 孫孝倫(Hsiao-Lun Sun)

《輔仁醫學期刊》 8卷1期 (2010/03) Pp. 39-47

摘要

糖尿病神經病變是最好發的糖尿病併發症。而糖尿病神經病變併發疼痛症狀則至少佔有三分之一。危險因子包含血糖控制不良，高血壓，身高，年紀，高膽固醇血症有關。糖尿病神經病變分類眾多，大多數皆會引起疼痛，而此疼痛多半影響睡眠，進而引發作息失調，慢性疲勞，肌肉無力，及憂鬱等症狀。本文將探討糖尿病神經病變好發神經痛的機制，及治療。

關鍵字

糖尿病神經痛 ； 糖尿病多發性神經病變 ； 第二型糖尿病

並列摘要

Background and purpose: The definition, clinical presentation, and treatment of diabetic neuropathic pain were reviewed. Results: The estimated prevalence of diabetic neuropathic pain is up to 22% based on a population of 270 million in the US. Diabetic neuropathy is one of themost common complications of type 2 diabetes mellitus (T2DM). Diabetic neuropathic pain is a sensorimotor neuropathy, or a distal symmetrical polyneuropathy, which is the most common type of excruciating, refractory pain in T2DM patients. Positive symptoms include pain and paresthesia. Patients complain about burning, tingling, aching, cold sensation, lancinating pain, numbness, or pain from normal touch. Painful symptoms occur in a part (11%-32%) of neuropathic patients with diabetes and do not correlate with diminished nerve conduction velocity. Thus electrophysiological testing is rarely needed according to the recommendations of the American Diabetes Association in 2010. The multifactorial pathogenesis of diabetic neuropathy suggested by recent research includes the polyol pathway, oxidative stress, advanced glycation end products, and protein kinase C. Medications for relief of diabetic neuropathic pain are recommended to improve the quality of life. For neuropathic pain control, the efficacy of tricyclic antidepressants, gabapentin, pregabalin, opioids, and tramadol is documented. Selective serotonin noradrenaline reuptake inhibitors, topical lidocaine, and transcutaneous electrical stimulation are therapies with some evidence of efficacy. Conclusions: Treatment is a great challenge, and has to be individualized to each patient, by taking into account side effects, pain type, comorbidities, and drug interactions. As poor glycemic control may worsen diabetic neuropathic pain, it is important to achieve a glucose target as rapidly as possible.

並列關鍵字

diabetic neuropathic pain ； distal symmetric polyneuropathy ； diabetic peripheral neuropathic pain ； type 2 diabetes mellitus