Терапия болевой диабетической невропатии

Парфенов В.А., Коняшова М.В. Терапия болевой диабетической невропатии. Consilium Medicum. 2021;23(11):841–846. DOI: 10.26442/20751753.2021.11.201230

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Parfenov VA, Konyashova MV. Treatment of painful diabetic neuropathy. Consilium Medicum. 2021;23(11):841–846. DOI: 10.26442/20751753.2021.11.201230

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Аннотация

Болевая диабетическая невропатия отмечается почти у половины пациентов с сахарным диабетом и ассоциируется со снижением качества жизни, эмоциональными расстройствами, нарушением сна. Достижение и поддержание нормального уровня глюкозы в крови составляют основу профилактики и лечения сахарного диабета, однако часто не позволяют избавить пациента от боли и других клинических проявлений невропатии. Обсуждаются лекарственные и нелекарственные методы терапии болевой диабетической невропатии, анализируются результаты рандомизированных плацебо-контролируемых исследований по эффективности и нежелательным явлениям различных лекарственных средств. Отмечается, что в качестве противоэпилептических средств наиболее эффективны прегабалин и габапентин, в качестве антидепрессантов – дулоксетин, венлафаксин и амитриптилин. В нашей стране при болевой диабетической невропатии широко используются препараты α-липоевой (тиоктовой) кислоты. Анализируются данные по эффективности и осложнениям применения чрескожной стимуляции нервов и спинного мозга при болевой диабетической невропатии, рефрактерной к лекарственной терапии. Отмечается, что многие пациенты с болевой диабетической невропатией имеют сочетанные заболевания, выявление и эффективное лечение которых может привести к улучшению состояния и уменьшить проявления невропатии.

Ключевые слова: болевая диабетическая невропатия, прегабалин, габапентин, Нейронтин, дулоксетин, венлафаксин, капсаицин, препараты α-липоевой кислоты, Тиоктацид, чрескожная электрическая стимуляция нервов, стимуляция спинного мозга

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Painful diabetic neuropathy is observed in almost half of patients with diabetes mellitus (DM) and is associated with a decrease in the quality of life, emotional disorders, sleep disorders. The achievement and maintenance of the normal level of glucose in the blood is the basis for the prevention and treatment of DM, but this often does not allow the patient from pain and other clinical manifestations of neuropathy. Drug diabetic neuropathy therapy methods are discussed, the results of randomized placebo controlled studies on the efficiency and side effects of various drugs are analyzed. It is noted that pregabalin and gabapenitin, as antidepressants – duloxetin, venlafaxin and amitriptyline, are most effective as anti-epileptic agents. In our country, with painful diabetic neuropathy, the preparations of a-lipoic acid are widely used. Analyzed data on efficacy and complications of the use of transcutaneus electrical nerves stimulation and spinal cord stimulation with pain diabetic neuropathy refractory to drug therapy. It is noted that many patients with pain diabetic neuropathy have combined diseases, detection and effective treatment of which can lead to an improvement in the state of patients and reduce the manifestations of neuropathy.

Keywords: painful diabetic neuropathy, pregabalin, gabapentine, Neurotine, duloxetine, venlafaxine, capsacin, a-lipoic acid preparations,
Thioctacid, percutaneous electrical stimulation of nerves, spinal cord stimulation

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Список литературы

1. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40:136-54. DOI:10.2337/dc16-2042
2. Gordois A, Scuffham P, Shearer A, et al. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003;26:1790-5. DOI:10.2337/diacare.26.6.1790
3. Ziegler D, Gries FA, Spuler M, Lessmann F. The epidemiology of diabetic neuropathy. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group. J Diabetes Complicat. 1992;6:49-57. DOI:10.1016/1056-8727(92)90049-Q
4. Kirthi V, Perumbalath A, Brown E, et al. Prevalence of peripheral neuropathy in prediabetes: a systematic review. BMJ Open Diab Res Care. 2021;9:e002040.
DOI:10.1136/bmjdrc-2020-002040
5. Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: Epidemiology, pain description, and quality of life. Diabetes Res Clin Pract. 2000;47:123-8.
DOI:10.1016/S0168-8227(99)00112-6
6. Deng Y, Luo L, Hu Y, et al. Clinical practice guidelines for the management of neuropathic pain: A systematic review. BMC Anesthesiol. 2016;16:12. DOI:10.1186/s12871-015-0150-5
7. Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: Clinical manifestations and current treatments. Lancet Neurol. 2012;11:521-34. DOI:10.1016/S1474-4422(12)70065-0
8. Staudt MD, Prabhala T, Sheldon BL, et al. Current Strategies for the Management of Painful Diabetic Neuropathy. J Diabetes Sci Technol. 2020. DOI:10.1177/1932296820951829
9. Gupta M, Knezevic NN, Abd-Elsayed A, et al. Treatment of Painful Diabetic Neuropathy – A Narrative Review of Pharmacological and Interventional Approaches. Biomedicines. 2021;9:573. DOI:10.3390/biomedicines9050573
10. Kluding PM, Bareiss SK, Hastings M, et al. Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift. Phys Ther. 2017;97(1):31-43. DOI:10.2522/ptj.20160124
11. Smith AG, Russell J, Feldman EL, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006;29(6):1294-9. DOI:10.2337/dc06-0224
12. Liampas A, Rekatsina M, Vadalouca A, et al. Non-Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review. Adv Ther. 2020;37:4096-106.
DOI:10.1007/s12325-020-01462-3
13. Rosenstock J, Tuchman M, LaMoreaux L, Sharma U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: A double-blind, placebo-controlled trial. Pain. 2004;110:628-38. DOI:10.1016/j.pain.2004.05.001
14. Backonja MM. Gabapentin monotherapy for the symptomatic treatment of painful neuropathy: A multicenter, double-blind, placebo-controlled trial in patients with diabetes mellitus. Epilepsia. 1999;40(Suppl. 6):S57-9, dis. S73-4.
DOI:10.1111/j.1528-1157.1999.tb00934.x
15. Wien PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2017;6:CD007938. DOI:10.1002/14651858.CD007938.pub4
16. Kremer M, Salvat E, Muller A, et al. Antidepressants and gabapentinoids in neuropathic pain: Mechanistic insights. Neuroscience. 2016;338:183-206. DOI:10.1016/j.neuroscience.2016.06.057
17. Raskin J, Pritchett YL, Wang F, et al. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med. 2005;6:346-56. DOI:10.1111/j.1526-4637.2005.00061.x
18. Goldstein DJ, Lu Y, Detke MJ, et al. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain. 2005;116:109-18. DOI:10.1016/j.pain.2005.03.029
19. Rowbotham MC, Goli V, Kunz NR, Lei D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: A double-blind, placebo-controlled study. Pain. 2004;110:697-706. DOI:10.1016/j.pain.2004.05.010
20. Rudroju N, Bansal D, Talakokkula ST, et al. Comparative efficacy and safety of six antidepressants and anticonvulsants in painful diabetic neuropathy: A network meta-analysis. Pain Physician. 2013;16:E705-14.
21. Schwartz S, Etropolski M, Shapiro DY, et al. Safety and efficacy of tapentadol ER in patients with painful diabetic peripheral neuropathy: Results of a randomized-withdrawal, placebo-controlled trial. Curr Med Res Opin. 2011;27:151-62. DOI:10.1185/03007995.2010.537589
22. Vinik AI, Shapiro DY, Rauschkolb C, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37:2302-9. DOI:10.2337/dc13-2291
23. Simpson DM, Robinson-Papp J, Van J, et al. Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study. J Pain. 2017;18:42-53. DOI:10.1016/j.jpain.2016.09.008
24. Singh U, Jialal I. Alpha-lipoic acid supplementation and diabetes. Nutr Rev. 2012;70(8):482.
25. Snedecor SJ, Sudharshan L, Cappelleri JC, et al. Systematic review and meta-analysis of pharmacological therapies for painful diabetic peripheral neuropathy. Pain Pract. 2014;14(2):167-84.
26. Mijnhout GS, Kollen BJ, Alkhalaf A, et al. Alpha lipoic acid for symptomatic peripheral neuropathy in patients with diabetes: A meta-analysis of randomized controlled trials. Int J Endocrinol. 2012:456279. DOI:10.1155/2012/456279
27. Ametov AS, Barinov A, Dyck PJ, et al: The sensory symptoms of diabetic polyneuropathy are improved with alpha lipoic acid: The SYDNEY trial. Diabetes Care. 2003;26:770-6. DOI:10.2337/diacare.26.3.770
28. Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011;34(9):2054-60.
29. Han T, Bai J, Liu W, Hu Y. A systematic review and meta analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur J Endocrinol. 2012;167:465-71. DOI:10.1530/EJE-12-0555
30. Thakral G, Kim PJ, LaFontaine J, et al. Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy. J. Diabetes Sci. Technol. 2013;7:1202-9. DOI:10.1177/193229681300700510
31. Bosi E, Bax G, Scionti L, et al. Frequency-modulated electromagnetic neural stimulation (FREMS) as a treatment for symptomatic diabetic neuropathy: Results from a double-blind, randomised, multicentre, long-term, placebo-controlled clinical trial. Diabetologia. 2013;56:467-75. DOI:10.1007/s00125-012-2795-7
32. De Vos CC, Meier K, Zaalberg PB, et al. Spinal cord stimulation in patients with painful diabetic neuropathy: A multicentre randomized clinical trial. Pain. 2014;155:2426-31. DOI:10.1016/j.pain.2014.08.031
33. Van Beek M, Slangen R, Schaper NC, et al. Sustained Treatment Effect of Spinal Cord Stimulation in Painful Diabetic Peripheral Neuropathy: 24-Month Follow-up of a Prospective Two-Center Randomized Controlled Trial. Diabetes Care. 2015;38:e132-4. DOI:10.2337/dc15-0740
34. Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial. JAMA Neurol. 2021. DOI:10.1001/jamaneurol.2021.0538
35. Onesti E, Gabriele M, Cambieri C, et al. H-coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy. Eur J Pain. 2013;17(9):1347-56.
36. Garrow AP, Xing M, Vere J, et al. Role of acupuncture in the management of diabetic painful neuropathy (DPN): a pilot RCT. Acupunct Med. 2014;32(3):242-9.
DOI:10.1136/acupmed-2013-010495
37. Cho E, Kim W. Effect of Acupuncture on Diabetic Neuropathy: A Narrative Review. Int J Mol Sci. 2021;22(16):8575. DOI:10.3390/ijms22168575
38. Парфенов В.А., Головачева В.А., Фадеев В.В., и др. Оптимизация ведения пациентов с диабетической полиневропатией с помощью междисциплинарного подхода. Медицинский совет. 2017;1S:71-9. [Parfenov VA, Golovacheva VA, Fadeev VV, et al. Optimization diabetic polyneuropathy patients management using a multidisciplinary approach. Meditsinskiy sovet (Medical Council). 2017;1S:71-9 (in Russian)]. DOI:10.21518/2079-701X-2017-0-71-79
39. Bril V, England J, Franklin GM, et al: Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American academy of neurology, the American association of neuromuscular and electrodiagnostic medicine, and the American academy of physical medicine and rehabilitation. Neurology. 2011;76:1758-65. DOI:10.1212/WNL.0b013e3182166ebe
40. Attal N, Cruccu G, Baron R, et al. European Federation of Neurological Societies: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17:1113-e88. DOI:10.1111/j.1468-1331.2010.02999.x

________________________________________________

1. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40:136-54. DOI:10.2337/dc16-2042
2. Gordois A, Scuffham P, Shearer A, et al. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003;26:1790-5. DOI:10.2337/diacare.26.6.1790
3. Ziegler D, Gries FA, Spuler M, Lessmann F. The epidemiology of diabetic neuropathy. Diabetic Cardiovascular Autonomic Neuropathy Multicenter Study Group. J Diabetes Complicat. 1992;6:49-57. DOI:10.1016/1056-8727(92)90049-Q
4. Kirthi V, Perumbalath A, Brown E, et al. Prevalence of peripheral neuropathy in prediabetes: a systematic review. BMJ Open Diab Res Care. 2021;9:e002040.
DOI:10.1136/bmjdrc-2020-002040
5. Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: Epidemiology, pain description, and quality of life. Diabetes Res Clin Pract. 2000;47:123-8.
DOI:10.1016/S0168-8227(99)00112-6
6. Deng Y, Luo L, Hu Y, et al. Clinical practice guidelines for the management of neuropathic pain: A systematic review. BMC Anesthesiol. 2016;16:12. DOI:10.1186/s12871-015-0150-5
7. Callaghan BC, Cheng HT, Stables CL, et al. Diabetic neuropathy: Clinical manifestations and current treatments. Lancet Neurol. 2012;11:521-34. DOI:10.1016/S1474-4422(12)70065-0
8. Staudt MD, Prabhala T, Sheldon BL, et al. Current Strategies for the Management of Painful Diabetic Neuropathy. J Diabetes Sci Technol. 2020. DOI:10.1177/1932296820951829
9. Gupta M, Knezevic NN, Abd-Elsayed A, et al. Treatment of Painful Diabetic Neuropathy – A Narrative Review of Pharmacological and Interventional Approaches. Biomedicines. 2021;9:573. DOI:10.3390/biomedicines9050573
10. Kluding PM, Bareiss SK, Hastings M, et al. Physical Training and Activity in People With Diabetic Peripheral Neuropathy: Paradigm Shift. Phys Ther. 2017;97(1):31-43. DOI:10.2522/ptj.20160124
11. Smith AG, Russell J, Feldman EL, et al. Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care. 2006;29(6):1294-9. DOI:10.2337/dc06-0224
12. Liampas A, Rekatsina M, Vadalouca A, et al. Non-Pharmacological Management of Painful Peripheral Neuropathies: A Systematic Review. Adv Ther. 2020;37:4096-106.
DOI:10.1007/s12325-020-01462-3
13. Rosenstock J, Tuchman M, LaMoreaux L, Sharma U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: A double-blind, placebo-controlled trial. Pain. 2004;110:628-38. DOI:10.1016/j.pain.2004.05.001
14. Backonja MM. Gabapentin monotherapy for the symptomatic treatment of painful neuropathy: A multicenter, double-blind, placebo-controlled trial in patients with diabetes mellitus. Epilepsia. 1999;40(Suppl. 6):S57-9, dis. S73-4.
DOI:10.1111/j.1528-1157.1999.tb00934.x
15. Wien PJ, Derry S, Bell RF, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database of Systematic Reviews. 2017;6:CD007938. DOI:10.1002/14651858.CD007938.pub4
16. Kremer M, Salvat E, Muller A, et al. Antidepressants and gabapentinoids in neuropathic pain: Mechanistic insights. Neuroscience. 2016;338:183-206. DOI:10.1016/j.neuroscience.2016.06.057
17. Raskin J, Pritchett YL, Wang F, et al. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med. 2005;6:346-56. DOI:10.1111/j.1526-4637.2005.00061.x
18. Goldstein DJ, Lu Y, Detke MJ, et al. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain. 2005;116:109-18. DOI:10.1016/j.pain.2005.03.029
19. Rowbotham MC, Goli V, Kunz NR, Lei D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: A double-blind, placebo-controlled study. Pain. 2004;110:697-706. DOI:10.1016/j.pain.2004.05.010
20. Rudroju N, Bansal D, Talakokkula ST, et al. Comparative efficacy and safety of six antidepressants and anticonvulsants in painful diabetic neuropathy: A network meta-analysis. Pain Physician. 2013;16:E705-14.
21. Schwartz S, Etropolski M, Shapiro DY, et al. Safety and efficacy of tapentadol ER in patients with painful diabetic peripheral neuropathy: Results of a randomized-withdrawal, placebo-controlled trial. Curr Med Res Opin. 2011;27:151-62. DOI:10.1185/03007995.2010.537589
22. Vinik AI, Shapiro DY, Rauschkolb C, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37:2302-9. DOI:10.2337/dc13-2291
23. Simpson DM, Robinson-Papp J, Van J, et al. Capsaicin 8% Patch in Painful Diabetic Peripheral Neuropathy: A Randomized, Double-Blind, Placebo-Controlled Study. J Pain. 2017;18:42-53. DOI:10.1016/j.jpain.2016.09.008
24. Singh U, Jialal I. Alpha-lipoic acid supplementation and diabetes. Nutr Rev. 2012;70(8):482.
25. Snedecor SJ, Sudharshan L, Cappelleri JC, et al. Systematic review and meta-analysis of pharmacological therapies for painful diabetic peripheral neuropathy. Pain Pract. 2014;14(2):167-84.
26. Mijnhout GS, Kollen BJ, Alkhalaf A, et al. Alpha lipoic acid for symptomatic peripheral neuropathy in patients with diabetes: A meta-analysis of randomized controlled trials. Int J Endocrinol. 2012:456279. DOI:10.1155/2012/456279
27. Ametov AS, Barinov A, Dyck PJ, et al: The sensory symptoms of diabetic polyneuropathy are improved with alpha lipoic acid: The SYDNEY trial. Diabetes Care. 2003;26:770-6. DOI:10.2337/diacare.26.3.770
28. Ziegler D, Low PA, Litchy WJ, et al. Efficacy and safety of antioxidant treatment with α-lipoic acid over 4 years in diabetic polyneuropathy: the NATHAN 1 trial. Diabetes Care. 2011;34(9):2054-60.
29. Han T, Bai J, Liu W, Hu Y. A systematic review and meta analysis of α-lipoic acid in the treatment of diabetic peripheral neuropathy. Eur J Endocrinol. 2012;167:465-71. DOI:10.1530/EJE-12-0555
30. Thakral G, Kim PJ, LaFontaine J, et al. Electrical stimulation as an adjunctive treatment of painful and sensory diabetic neuropathy. J. Diabetes Sci. Technol. 2013;7:1202-9. DOI:10.1177/193229681300700510
31. Bosi E, Bax G, Scionti L, et al. Frequency-modulated electromagnetic neural stimulation (FREMS) as a treatment for symptomatic diabetic neuropathy: Results from a double-blind, randomised, multicentre, long-term, placebo-controlled clinical trial. Diabetologia. 2013;56:467-75. DOI:10.1007/s00125-012-2795-7
32. De Vos CC, Meier K, Zaalberg PB, et al. Spinal cord stimulation in patients with painful diabetic neuropathy: A multicentre randomized clinical trial. Pain. 2014;155:2426-31. DOI:10.1016/j.pain.2014.08.031
33. Van Beek M, Slangen R, Schaper NC, et al. Sustained Treatment Effect of Spinal Cord Stimulation in Painful Diabetic Peripheral Neuropathy: 24-Month Follow-up of a Prospective Two-Center Randomized Controlled Trial. Diabetes Care. 2015;38:e132-4. DOI:10.2337/dc15-0740
34. Petersen EA, Stauss TG, Scowcroft JA, et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial. JAMA Neurol. 2021. DOI:10.1001/jamaneurol.2021.0538
35. Onesti E, Gabriele M, Cambieri C, et al. H-coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy. Eur J Pain. 2013;17(9):1347-56.
36. Garrow AP, Xing M, Vere J, et al. Role of acupuncture in the management of diabetic painful neuropathy (DPN): a pilot RCT. Acupunct Med. 2014;32(3):242-9.
DOI:10.1136/acupmed-2013-010495
37. Cho E, Kim W. Effect of Acupuncture on Diabetic Neuropathy: A Narrative Review. Int J Mol Sci. 2021;22(16):8575. DOI:10.3390/ijms22168575
38. Parfenov VA, Golovacheva VA, Fadeev VV, et al. Optimization diabetic polyneuropathy patients management using a multidisciplinary approach. Meditsinskiy sovet (Medical Council). 2017;1S:71-9 (in Russian). DOI:10.21518/2079-701X-2017-0-71-79
39. Bril V, England J, Franklin GM, et al: Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American academy of neurology, the American association of neuromuscular and electrodiagnostic medicine, and the American academy of physical medicine and rehabilitation. Neurology. 2011;76:1758-65. DOI:10.1212/WNL.0b013e3182166ebe
40. Attal N, Cruccu G, Baron R, et al. European Federation of Neurological Societies: EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17:1113-e88. DOI:10.1111/j.1468-1331.2010.02999.x

Авторы

В.А. Парфенов*, М.В. Коняшова

ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*vladimirparfenov@mail.ru

________________________________________________

Vladimir A. Parfenov*, Mariya V. Konyashova

Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*vladimirparfenov@mail.ru

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