A Highly Successful and Novel Model for Treatment of Chronic Painful Diabetic Peripheral Neuropathy
- Michael A Pfeifer, MS, MD,
- David R Ross, MD,
- Jon P Schrage, MD,
- David A Gelber, MD,
- Mary P Schumer, MS,
- Goldie M Crain,
- Stephen J Markwell, MA and
- Sonya Jung, MS, MSN
- Diabetes Research and Treatment Center at Southern Illinois University, and Southern Illinois University School of Medicine Springfield, Illinois Diabetes Center of Excellence, Humana Hospital-Lexington Lexington, Kentucky
- Address correspondence and reprint requests to Michael A. Pfeifer, MS, MD, Associate Professor of Medicine, Diabetes Research and Treatment Center at Southern Illinois University, Division of Endocrinology/Metabolism/Nutrition, St. John's Pavilion, 301 North 8th Street, Room 4B115, Springfield, IL 61702.
Abstract
OBJECTIVE To investigate why, in spite of a vast variety of treatment agents, the alleviation of pain in patients with diabetic neuropathy is difficult. Previous studies have not used a treatment algorithm based on anatomic site and neuropathophysiological source of the neuropathic pain.
RESEARCH DESIGN AND METHODS A model that categorizes the types of pain into three groups (superficial, deep, and muscular) was applied in 75 diabetic patients with chronic (> 12 mo) painful distal symmetrical polyneuropathy in a controlled case series. Twenty-two patients were untreated and 53 patients were treated with imipramine ± mexiletine for deep pain, capsaicin for superficial pain, and stretching exercises and metaxalone ± piroxican for muscular pain. Each type of pain was scored separately on a scale of 0 (none) to 19 (worst), and the total of all three types was used as an index of overall pain. Ability to sleep through the night was scored by a scale of 1 (never) to 5 (always).
RESULTS No significant differences were observed in initial pain scores, sleep scores, demographics, biochemistries, or physical findings between the two groups. After 3 mo a significant improvement in scores was noted in the treated but not the untreated patients. In addition, a significant difference was found in the change of scores between the treated and untreated patients: total pain (−18 ± 2 vs. 0 ± 2), deep pain (−7 ± 1 vs. 0 ± 1), superficial pain (−5 ± 1 vs. 0 ± 1), muscular pain (−6 ± 1 vs. 0 ± 1), and sleep (1.2 ± 0.2 vs. 0.2 ± 0.2), all P < 0.0001. In treated patients 21% became pain-free (total pain < 2), 66% had improvement (decrease in total pain > 5, but not total elimination of painful symptoms), and 13% were considered treatment failures (a decrease in total pain of < or = 5). This compares with 0 (P < 0.02), 10 (P < 0.0001), and 90% (P < 0.0001), respectively, in the untreated patients.
CONCLUSIONS This study presents a new rationale and hypothesis for the successful treatment of chronic painful diabetic peripheral neuropathy. It uniquely bases the treatment algorithm on the types and sources of the pain.
- Received October 13, 1993.
- Revision received December 1, 1993.
- Accepted April 1, 1993.
- Copyright © 1993 by the American Diabetes Association
