HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Purchase Article View Shopping Cart Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Yuen, K. C.J. Articles by Rayman, G. Search for Related Content PubMed PubMed Citation Articles by Yuen, K. C.J. Articles by Rayman, G. Social Bookmarking                What's this?

Treatment of Chronic Painful Diabetic Neuropathy With Isosorbide Dinitrate Spray

A double-blind placebo-controlled cross-over study

¹ Eleanor Cripps Diabetes and Endocrine Centre, Addenbrooke’s Hospital, Cambridge
² Diabetes Centre, Ipswich Hospital NHS Trust, Ipswich, U.K.

OBJECTIVE—Considerable evidence implicates impaired nitric oxide (NO) generation in the pathogenesis of diabetic neuropathic pain. We therefore conducted a pilot study to examine the effects of isosorbide dinitrate (ISDN), a NO donor with local vasodilating properties, in spray form in the management of chronic neuropathic pain.

RESEARCH DESIGN AND METHODS—The study was of double-blind, randomized, placebo-controlled, and two-period cross-over design. After a 2-week run-in period, 22 diabetic patients (13 men, 20 with type 2 diabetes, age [mean ± SE] 63.7 ± 1.8 years, duration of diabetes 9.1 ± 1.5 years, duration of painful neuropathy 2.6 ± 0.4 years) were randomized to receive ISDN or placebo sprays for 4 weeks, exchanging their treatment for a further 4 weeks after a 2-week wash-out period. The patients administered the spray to both feet before bedtime. Biweekly pain and other sensory symptoms were assessed using a visual analog scale (VAS) and the Lickert scale, respectively.

RESULTS—ISDN spray reduced overall neuropathic pain (P = 0.02) and burning sensation (P = 0.006). No treatment difference was observed with other sensory modalities (hot/cold sensation, tingling, numbness, hyperesthesia, and jabbing-like sensation). At study completion, 11 patients (50%) reported benefit and wished to continue using the ISDN spray, 4 (18%) preferred the placebo spray, and the remaining 7 (32%) were undecided.

CONCLUSIONS—ISDN spray offers an alternative and effective pharmacological option in relieving overall pain and burning sensation in the management of painful diabetic neuropathy. The potential of ISDN spray in alleviating other specific sensory symptoms associated with diabetic peripheral neuropathy merits further study.

Abbreviations: ISDN, isosorbide dinitrate • PVD, peripheral vascular disease • VAS, visual analog scale

CiteULike    Del.icio.us    Digg    Reddit    Technorati    What's this?

This article has been cited by other articles:

				R. Sanchez-Vazquez, G. Briseno-Rodriguez, E. G. Cardona-Munoz, F. J. Galvez-Gastelum, S. E. Totsuka-Sutto, and L. Garcia-Benavides Isosorbide Dinitrate Spray as Therapeutic Strategy for Treatment of Chronic Venous Ulcers Angiology, March 1, 2008; 59(1): 64 - 71. [Abstract] [PDF]

				R. G. Smith Painful Diabetic Peripheral Neuropathy J Am Podiatr Med Assoc, September 1, 2007; 97(5): 394 - 401. [Abstract] [Full Text] [PDF]

				C. Quattrini, N. D. Harris, R. A. Malik, and S. Tesfaye Impaired Skin Microvascular Reactivity in Painful Diabetic Neuropathy Diabetes Care, March 1, 2007; 30(3): 655 - 659. [Abstract] [Full Text] [PDF]

				P. J. Kim, L. C. Ballinger, and D. Kushner Effect of a nitroglycerin patch on perfusion to the foot in healthy subjects. J Am Podiatr Med Assoc, July 1, 2006; 96(4): 318 - 322. [Abstract] [Full Text] [PDF]

				C. F. Corbett Practical Management of Patients With Painful Diabetic Neuropathy The Diabetes Educator, July 1, 2005; 31(4): 523 - 540. [Abstract] [Full Text] [PDF]

				A. J.M. Boulton Management of Diabetic Peripheral Neuropathy Clin. Diabetes, January 1, 2005; 23(1): 9 - 15. [Abstract] [Full Text] [PDF]

				A. J.M. Boulton, R. A. Malik, J. C. Arezzo, and J. M. Sosenko Diabetic Somatic Neuropathies Diabetes Care, June 1, 2004; 27(6): 1458 - 1486. [Full Text] [PDF]

				J. F. Reed III Crossover Designs in Lower Extremity Wounds International Journal of Lower Extremity Wounds, September 1, 2003; 2(3): 158 - 163. [Abstract] [PDF]

				G. Rayman, N. R. Baker, and S. T.M. Krishnan Glyceryl Trinitrate Patches as an Alternative to Isosorbide Dinitrate Spray in the Treatment of Chronic Painful Diabetic Neuropathy Diabetes Care, September 1, 2003; 26(9): 2697 - 2698. [Full Text] [PDF]