Painful diabetic neuropathy

Abstract

Pain is probably the most distressing symptom of diabetic neuropathy (1). The features of pain in diabetic neuropathy were clearly documented by Pavy (2), who observed, that it was of burning and unremitting quality often with a nocturnal exacerbation. Indeed the quality of neuropathic pain has been described as burning, shooting, lancinating, prickling, and aching in character, often with many of these symptoms manifesting in the same patient (3). Some patients describe these symptoms as the feeling of walking barefoot on hot sand or pebbles. Others describe an odd sensation of their legs feeling swollen. The intensity of neuropathic pain is also variable among different individuals and often varies with time in the same individual. Some patients may have mild paresthesia in one or two toes; others may have intolerable unremitting pain involving both legs (4). Most patients with chronic, painful neuropathy have a moderate background pain with relatively short intervals of peak neuropathic pain. Sleep is often disturbed because of the nocturnal exacerbation of these symptoms, in addition to allodynia (contact hypersensitivity to bed clothes) (4). In some patients, neuropathic pain can be so disabling as to lead to loss of employment, reduction in exercise tolerance, and hence interference with daily activities, a reduction in recreational activities, and depression (4,5).