Pain Management in People with Diabetes-Related Chronic Limb-Threatening Ischemia.

Yi Yuan,Xiaodong Duan,Johnson Boey,David G Armstrong,Wuquan Deng,Xiaoyan Jiang,Chenzhen Du,Miao Zhong,Yu Ma,Agata Stanek

doi:10.1155/2021/6699292

Abstract

Management of neuropathic pain in people with diabetes has been widely investigated. However, little attention was paid to address ischemic-related pain in patients with diabetes mellitus who suffered from chronic limb-threatening ischemia (CLTI), the end stage of lower extremity arterial disease (LEAD). Pain management has a tremendous influence on patients' quality of life and prognosis. Poor management of this type of pain owing to the lack of full understanding undermines patients' physical and mental quality of life, which often results in a grim prognosis, such as depression, myocardial infarction, lower limb amputation, and even mortality. In the present article, we review the current strategy in the pain management of diabetes-related CLTI. The endovascular therapy, pharmacological therapies, and other optional methods could be selected following comprehensive assessments to mitigate ischemic-related pain, in line with our current clinical practice. It is very important for clinicians and patients to strengthen the understanding and build intervention strategy in ischemic pain management and possible adverse consequence.

Highlights

Lower extremity arterial disease (LEAD) in diabetes is a leading cause of limb loss and has a profoundly negative impact on quality of life and early mortality [1]
We present a case of progressive gangrene without a previous history of LEAD and the development of rest pain, all of which have been largely disparaged by the patient until the lower limb amputation has to be considered
The management of pain in people with diabetes and chronic limb-threatening ischemia (CLTI) remains a challenge. This is due to the complex pathophysiology of pain in CLTI, limited research base with pharmacological management, varying subjective feelings and severity of individuals, and varying degrees of pain relief for optional treatment approaches

Summary

Introduction

Lower extremity arterial disease (LEAD) in diabetes is a leading cause of limb loss and has a profoundly negative impact on quality of life and early mortality [1]. Many individuals with LEAD have a higher amputation rate and mortality and experience ischemic pain [6,7,8]. No randomized clinical trial has been conducted, and no specific practice recommendation has been provided in the management of ischemic pain in patients with CLI [5]. We intend to discuss the current therapeutic approach for the management of ischemic-related pain in patients with diabetes-related CLTI through our clinical cases. The emerging new definition of chronic limbthreatening ischemia (CLTI) is mainly characterized by rest pain, with or without skin ulcer or gangrene, which has replaced the term CLI in recent guidelines [5, 14]. A recent position statement released by the European Society of Vascular Medicine suggests the inclusion of nonhealing leg ulceration of other origin into the definition of CLTI due to their poor prognosis and to consider the impact of frailty on adverse outcome [16]

Epidemiology of Diabetes-Related CLTI

Pain Characteristic of Diabetes-Related CLTI

Intervention of Pain Management in CLTI

Findings

Conclusion