Effects Of Peripheral Neuropathy Research Articles

The Effect of Peripheral Neuropathy on Disability and Anxiety

The Effect of Peripheral Neuropathy on Disability and Anxiety

Effect of peripheral neuropathy on bone mineral density in adults with diabetes: A systematic review of the literature and meta-analysis.

Peripheral neuropathy occurs in two thirds of patients with diabetes mellitus (DM). It can lead to severe pathological changes in the feet, and it increases the risk of fracture more than any other diabetic complication. The objective of this review is to analyze available literature on the effect of peripheral neuropathy on BMD of the foot, spine, or hip. We hypothesize that the presence of diabetic neuropathy leads to lower BMD in adults with diabetes. Original studies investigating the effects of diabetic neuropathy on bone density were searched for inclusion in this systematic review. Studies were eligible if they met the following criteria: 1) participants included adults with either Type 1 DM or Type 2 DM; 2) Method used for the diagnosis of neuropathy described in the manuscript 3) DXA scan, ultrasound, or CT scan was used to measure proximal femur, spine, or foot bone mineral density were reported, and 4) bone parameters were analyzed based on the presence and absence of neuropathy. Among the 5 studies that met eligibility criteria, 4 did not find a significant effect of neuropathy on BMD. One study showed a significant negative impact of neuropathy on calcaneal BMD in patients with type 1 diabetes. The meta-analysis did not show a significant effect of peripheral neuropathy on BMDs of proximal femur, spine, and calcaneus in diabetic adults. Our study shows no evidence that peripheral neuropathy affects bone density or bone turnover in DM. However, this conclusion should be taken with caution since only a very limited number of studies were available for inclusion in the analysis and included both type 1 and type 2 DM patients. Improved measures of peripheral neuropathy and more advanced imaging technologies are needed to better assess the effect of diabetes on bone health.

The effect of peripheral neuropathy on daily life activities in patients receiving chemotherapy

Objective: The aim of this study is to determine the relationship between pain and pain related factors associated with peripheral neuropathy and daily life activities in patients receiving chemotherapy.Methods: The study used a descriptive and cross-sectional design to examine 80 patients who came to the outpatient chemotherapy unit of two university hospitals to receive chemotherapy drugs such as taxane, platinum analogs and vinca alkaloids. The data were collected by using face-to-face interview method through “General Information Form”, “S-LANSS Pain Scale” that is a bedside test for distinctive diagnosis of neuropathic pain and “Health Assessment Questionnaire (HAQ)” which is a scale prepared by the researcher and measures daily activities to evaluate physical disability.Results: In the group with neuropathic pain, HAQ scores (p = .003; p < .01) and S-LANSS scores (p = .005; p < .01) of the patients who did not have hand-foot complaints prior to the treatment but experienced hand-foot discomfort with the beginning of chemotherapy treatment, were found to be statistically significantly higher. There was a statistically significant positive relation between HAQ score and S-LANSS pain score at the level of 61.2% (r = 0.612; p = .001; p < .01).Conclusions: It was concluded that the symptoms of Chemotherapy-Induced Peripheral Neuropathy (CIPN) and related pain and pain-related factors negatively affect the level of doing daily life activities.

Neuropathy, claw toes, intrinsic muscle volume, and plantar aponeurosis thickness in diabetic feet

BackgroundThe objective of this study was to explore the relationships between claw toe deformity, peripheral neuropathy, intrinsic muscle volume, and plantar aponeurosis thickness using computed tomography (CT) images of diabetic feet in a cross-sectional analysis.MethodsForty randomly-selected subjects with type 2 diabetes were selected for each of the following four groups (n = 10 per group): 1) peripheral neuropathy with claw toes, 2) peripheral neuropathy without claw toes, 3) non-neuropathic with claw toes, and 4) non-neuropathic without claw toes. The intrinsic muscles of the foot were segmented from processed CT images. Plantar aponeurosis thickness was measured in the reformatted sagittal plane at 20% of the distance from the most inferior point of the calcaneus to the most inferior point of the second metatarsal. Five measurement sites in the medial-lateral direction were utilized to fully characterize the plantar aponeurosis thickness. A linear mixed-effects analysis on the effects of peripheral neuropathy and claw toe deformity on plantar aponeurosis thickness and intrinsic muscle volume was performed.ResultsSubjects with concurrent neuropathy and claw toes had thicker mean plantar aponeurosis (p < 0.006) and may have had less mean intrinsic muscle volume (p = 0.083) than the other 3 groups. The effects of neuropathy and claw toes on aponeurosis thickness were synergistic rather than additive. A similar pattern may exist for intrinsic muscle volume, but results were not as conclusive. A negative correlation was observed between plantar aponeurosis thickness and intrinsic muscle volume (R2 = 0.323, p < 0.001).ConclusionsSubjects with concurrent neuropathy and claw toe deformity were associated with the smallest intrinsic foot muscle volumes and the thickest plantar aponeuroses. Intrinsic muscle atrophy and plantar aponeurosis thickening may be related to the development of claw toes in the presence of neuropathy.

Retrospective review of chronic pain causes and management in multiple myeloma patients.

e20552 Background: The survival of patients with multiple myeloma has improved dramatically since the introduction of proteasome inhibitors such as bortezomib, which can have the adverse effect of peripheral neuropathy. This study retrospectively examines causes of chronic pain in myeloma patients and the modalities and duration of treatments used for pain control. Methods: Rush University Medical Center multiple myeloma patients who were diagnosed and treated between 2000-2019 were included. Outcome measures were abstracted from the medical record and included: classes of pain medication used, duration of treatment, prevalence of peripheral neuropathy symptoms, and use of adjunct treatment modalities. Descriptive statistical models including Chi-square and Fisher’s exact test were used for categorical variable analysis. Results: In all, 134 patients were included, of which 75.4% (N = 101) patients received at least one cycle of bortezomib. 42.5% (N = 57) patients were seen in palliative clinic. 72.9% (N = 97) reported bone pain symptoms. A total of 73.7% (N = 98) patients experienced peripheral neuropathy symptoms. 86.1% (N = 87) of patients who received bortezomib reported neuropathy, as compared to 34.4% (N = 11) of patients who did not have bortezomib therapy (OR 11.8, p &lt; 0.0001). 66.4% (N = 67) patients who received bortezomib took anticonvulsants as compared to 31.3% (N = 10) of those who did not receive bortezomib (OR 4.3, p &lt; 0.0005). Patients were on anticonvulsant therapy for a mean of 32.6 months (SD = 26.7) with no significant difference in the bortezomib group. 79.7% (N = 106) patients took opioid medications. Norco was the most commonly used opioid (N = 55) and average duration of use was 36.6 months (SD = 34). 18.8% (N = 25) took antidepressant medications such as TCAs or SNRIs for pain, and all of these patients received bortezomib therapy (p = 0.0003). 36.6% (N = 45) of patients received radiation and 16.5% (N = 22) underwent kyphoplasty. 70.7% (N = 94) patients attended at least one physical therapy session. There was no statistically significant difference in radiation or kyphoplasty utilization between patients who had received bortezomib and those who had not, but there was a significant difference in physical therapy (OR 4.9, p &lt; 0.0001). Conclusions: Patients who received bortezomib as part of their myeloma treatment were more likely to experience peripheral neuropathy and required anticonvulsant therapy more frequently. It is important to better understand and define the health burden of chronic pain and use of pain medications in patients with multiple myeloma.

Factors Associated with Occurrence of Peripheral Neuropathy among HIV/AIDS Clients at Kombewa Sub County Hospital of Kisumu County, Kenya

Peripheral Neuropathy (PN) commonly arises as HIV related nerve complication. The study made attempts to assess the underlying factors leading to peripheral neuropathy, the disabling effects of peripheral neuropathy on a patient’s life quality and measures which can be implemented to prevent or lessen the burdening effects of these neuropathies. A descriptive design was adopted where cross-sectional data targeting a sample of 100 consenting adult HIV/AIDS clients were collected utilizing structured questionnaires as key instruments of data collection. In this study variables such as age, height, the past and current CD4 lymphocytes, the viral load, the average duration of antiretroviral treatment (ART), use and the presence of certain co-infection, diabetes or alcohol abuse were analyzed to determine their effects of occurrence of peripheral neuropathy. Fifty eight percent (58%) of the clients were classified to be having neuropathic as compared 42% who did not have neuropathic pain. Duration of diagnosis with HIV and previous CD4 count did not significantly determine the occurrence of neuropathic pain. Viral load at time of diagnosis with HIV; nutritional uptake and HAART regimen significantly contribute to occurrence of PN among HIV/AIDS clients. There was no significant association between cases of peripheral neuropathy and demographic factors such as age, gender, height of the respondents and level of education. Clients with peripheral neuropathy were not receiving adequate health talks on peripheral neuropathy. Effect of PN on physical activity was observed. There is need for providing both medical and palliative treatment to HIV/AIDS patients suffering from peripheral neuropathy.

The effect of peripheral neuropathy on lower limb muscle strength in diabetic individuals

BackgroundSkeletal muscle strength is poorly described and understood in diabetic participants with diabetic peripheral neuropathy. This study aimed to investigate the extensor and flexor torque of the knee and ankle during concentric, eccentric, and isometric contractions in men with diabetes mellitus type 2 with and without diabetic peripheral neuropathy. MethodsThree groups of adult men (n=92), similar in age, body mass index, and testosterone levels, were analyzed: 33 non-diabetic controls, 31 with type 2 diabetes mellitus, and 28 with diabetic peripheral neuropathy. The peak torques in the concentric, eccentric, and isometric contractions were evaluated using an isokinetic dynamometer during knee and ankle flexion and extension. FindingsIndividuals with diabetes and diabetic peripheral neuropathy presented similar low concentric and isometric knee and ankle torques that were also lower than the controls. However, the eccentric torque was similar among the groups, the contractions, and the joints. InterpretationRegardless of the presence of peripheral neuropathy, differences in skeletal muscle function were found. The muscle involvement does not follow the same pattern of sensorial losses, since there are no distal-to-proximal impairments. Both knee and ankle were affected, but the effect sizes of the concentric and isometric torques were found to be greater in the participants' knees than in their ankles. The eccentric function did not reveal differences between the healthy control group and the two diabetic groups, raising questions about the involvement of the passive muscle components.

Effects of peripheral neuropathy on exercise capacity and quality of life in patients with chronic obstructive pulmonary diseases.

IntroductionChronic obstructive pulmonary diseases (COPD) have some systemic effects including systemic inflammation, nutritional abnormalities, skeletal muscle dysfunction, and cardiovascular, skeletal and neurological disorders. Some studies have reported the presence of peripheral neuropathy (PNP) at an incidence of 28-94% in patients with COPD. Our study aimed to identify whether PNP affects exercise performance and quality of life in COPD patients.Material and methodsThirty mild-very severe patients with COPD (male/female = 29/1, mean age = 64 ±10 years) and 14 normal subjects (male/female = 11/5, mean age = 61 ±8 years) were included in the present study. All subjects underwent pulmonary function testing (PFT), cardiopulmonary exercise testing, electroneuromyography and short form 36 (SF-36).ResultsPeak oxygen uptake (PeakVO2) was lower in COPD patients (1.15 ±0.53 l/min) than healthy subjects (2.02 ±0.46 l/min) (p = 0.0001). There was no PNP in healthy subjects while 16 (53%) of the COPD patients had PNP. Forced expiratory volume in 1 s (FEV1) and PeakVO2 were significantly different between patients with PNP and those without (p = 0.009, p = 0.03 respectively). Quality of life of patients with PNP was lower than that of patients without PNP (p < 0.05).ConclusionsThe present study demonstrates the exercise limitation in COPD patients with PNP. Thus, presence of PNP has a poor effect on exercise capacity and quality of life in patients with COPD. Furthermore, treatment modalities for PNP can be recommended to these patients in order to improve exercise capacity and quality of life.

Effects of Peripheral Neuropathy on CTB-labeled Motor Neurons Following Ligation of the Tibial Nerve

Changes in CTB labeled motor neurons of the spinal cord were observed after the induction of peripheral neuropathy by ligation of the tibial nerve. Rats were anesthetized and the tibial nerve was ligated with 3-0 silk. The rats were separated into three groups based on the length of time the tibial nerve was ligated (1, 2, or 4 weeks). After the ligation procedures were complete, the tibial nerve stumps were soaked in CTB solution. Tibial nerve segments and the spinal cord were then observed. In the control and experimental groups, CTB-labeled neurons formed a discrete population that was concentrated primarily at the L5 level, while the contributions from L4 and L6 were minor. According to the distributions, CTBlabeled neurons were divided into rostral and caudal groups. A selective decrease of CTB-labeled neurons was observed only in the caudal group, extending from the rostral L5 to one-half of the rostral L6. The total numbers of CTB-labeled motor neurons were 2,160±169.3, 1,002±245.1, 587.5±346.5, and 1,728±402.6 in the control group, 1 week group, 2 week group, and 4 week group, respectively. The selective decrease of CTB-labeled neurons in the caudal division was responsible for the decrease in the total number of labeled neurons in all groups. Following peripheral neuropathy caused by ligation of the tibial nerve, CTB-labeled neurons in the spinal cord decreased selectively. These results may provide important neuroanatomical data regarding the effects of peripheral neuropathy by ligation of the tibial nerve.

Review Article: Palliative Oncology: Thalidomide

After decades of disuse because of its teratogenic effects, thalidomide has had a resurgence of use as a promising therapeutic agent for multiple myeloma. Its mechanism of action involves activation of the immune system, antiangiogenic effects, and inhibition of cytokines. Thalidomide does not interact with the cytochrome oxidase system. It is not significantly metabolized, but it does undergo nonenzymatic hydrolysis in plasma. The resulting products are inactive. Despite the potential adverse effects of peripheral neuropathy, constipation, deep vein thrombosis, somnolence, rash, and orthostatic hypotension, thalidomide is an effective first-line agent for multiple myeloma in combination with dexamethasone or melphalan and prednisone. It has also been studied in the palliative care of patients with cytokine-based syndromes such as anorexia-cachexia syndrome. This review describes its use in oncology, hematology, and palliative care.