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Мультимодальный подход к лечению болевой формы диабетической нейропатии
Мандра Е.В., Ким А.Д. Мультимодальный подход к лечению болевой формы диабетической нейропатии. Consilium Medicum. 2024;26(11):759–762. DOI: 10.26442/20751753.2024.11.202819
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
© ООО «КОНСИЛИУМ МЕДИКУМ», 2024 г.
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Mandra EV, Kim AD. A multimodal approach to the treatment of painful diabetic neuropathy. Case report. Consilium Medicum. 2024;26(11):759–762. DOI: 10.26442/20751753.2024.11.202819
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Аннотация
При болевой форме диабетической полинейропатии (ДПН) эффективен комплексный подход, включающий кинезиотерапию, гигиену сна, образовательную программу, при показаниях – лекарственные средства. Представлено наблюдение пациентки с сахарным диабетом 1-го типа, длительно страдающей болевой формой ДПН. Продолжительное время пациентка проходила курсы метаболической терапии, принимала антиконвульсант в дозах, не соответствующих максимально безопасным при диабетической нефропатии. В неврологическом центре пациентке скорректированы дозировки принимаемых анальгетиков, подобрана комплексная терапия для коррекции сопутствующих патологий. Через 3 мес на фоне проводимой терапии у пациентки наблюдалось снижение интенсивности нейропатического болевого синдрома в ногах, отмечались снижение уровня гиподинамии, частичная нормализация эмоционального состояния и нормализация качества сна. В статье обсуждаются факторы риска развития нейропатической боли при ДПН, эффективные методы ее коррекции в рамках мультидисциплинарного подхода.
Ключевые слова: диабетическая полинейропатия, нейропатическая боль, кинезиотерапия, лечебная гимнастика, когнитивно-поведенческая терапия, хроническая инсомния, эмоциональные нарушения
Ключевые слова: диабетическая полинейропатия, нейропатическая боль, кинезиотерапия, лечебная гимнастика, когнитивно-поведенческая терапия, хроническая инсомния, эмоциональные нарушения
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In painful diabetic polyneuropathy (DPN), an integrated approach is effective, including kinesiotherapy, sleep hygiene, an educational program, and pharmacological agents if indicated. A case of a patient with type 1 diabetes mellitus and a painful DPN is presented. The patient received metabolic therapy for a long time, an anticonvulsant at doses that are not the safest in diabetic nephropathy. At the neurological center, the patient's dosage of analgesics was adjusted, and a complex therapy was tailored to improve comorbidities. After 3 months, during therapy, the patient reported decreased neuropathic pain in the legs, decreased hypodynamia level, partial normalization of her emotional state, and normalization of sleep quality. Risk factors for developing neuropathic pain in DPN and effective methods for its treatment as part of a multidisciplinary approach are discussed.
Keywords: diabetic polyneuropathy, neuropathic pain, kinesiotherapy, therapeutic gymnastics, cognitive behavioral therapy, chronic insomnia, emotional disorders
Полный текст
Список литературы
1. International Diabetes Federation. 2024. Available at: https://idf.org/about-diabetes/diabetes-facts-figures/ Accessed: 15.05.2024.
2. Kirthi V, Perumbalath A, Brown E, et al. Prevalence of peripheral neuropathy in pre-diabetes: a systematic review. BMJ Open Diabetes Res Care. 2021;9(1):e002040. DOI:10.1136/bmjdrc-2020-002040
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13. Themistocleous AC, Ramirez JD, Shillo PR, et al. The Pain in Neuropathy Study (PiNS): a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy. Pain. 2016;157(5):1132-45. DOI:10.1097/j.pain.0000000000000491
14. Jambart S, Ammache Z, Haddad F, et al. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res. 2011;39(2):366-77. DOI:10.1177/147323001103900204
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19. Полуэктов М.Г., Головатюк А.О. Нарушения сна при острой и хронической боли. Неврология, нейропсихиатрия, психосоматика. 2021;13(3):125-30 [Poluektov MG, Golovatyuk AO. Sleep disorders in acute and chronic pain. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):125-30 (in Russian)]. DOI:10.14412/2074-2711-2021-3-125-130
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22. Головачева В.А., Головачева А.А., Голубев В.Л. Практические принципы лечения хронической неспецифической боли в нижней части спины и коморбидной хронической инсомнии: клиническое наблюдение. Медицинский совет. 2021;(10):164-70 [Golovacheva VA, Golovacheva AA, Golubev VL. Practical principles of treatment of chronic nonspecific pain in the lower back and comorbid chronic insomnia: clinical observation. Medical Council. 2021;(10):164-70 (in Russian)]. DOI:10.21518/2079-701X-2021-10-164-170
23. Головатюк А.О., Полуэктов М.Г. Эффективность дистанционных методов когнитивно-поведенческой терапии хронической инсомнии и возможности применения комбинированных подходов. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2023;123(5‑2):58‑62 [Golovatyuk AO, Poluektov MG. The effectiveness of remote methods of cognitive behavioral therapy for chronic insomnia and the possibility of using combined approaches. Journal of Neurology and Psychiatry named after S.S. Korsakov. Special issues. 2023;123(5‑2):58‑62 (in Russian)]. DOI:10.17116/jnevro202312305258
24. D’Amato C, Morganti R, Greco C, et al. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res. 2016;13(6):418-28. DOI:10.1177/1479164116653240
25. Kec D, Rajdova A, Raputova J, et al. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study. Eur J Pain. 2022;26(2):370-89. DOI:10.1002/ejp.1865
26. Головачева В.А., Табеева Г.Р., Фатеева Т.Г. Ведение пациентов со скелетно-мышечной болью в спине и коморбидной тревогой. Медицинский Совет. 2022;(23):60-6 [Golovacheva VA, Tabeeva GR, Fateeva TG. Management of patients with musculoskeletal back pain and comorbid anxiety. Medical Council. 2022;(23):60-6 (in Russian)]. DOI:10.21518/2079-701X-2022-16-23-60-66
2. Kirthi V, Perumbalath A, Brown E, et al. Prevalence of peripheral neuropathy in pre-diabetes: a systematic review. BMJ Open Diabetes Res Care. 2021;9(1):e002040. DOI:10.1136/bmjdrc-2020-002040
3. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54.
DOI:10.2337/dc16-2042
4. Callaghan BC, Gallagher G, Fridman V, Feldman EL. Diabetic neuropathy: what does the future hold? Diabetologia. 2020;63(5):891-7. DOI:10.1007/s00125-020-05085-9
5. Shi Y, Wu W. Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress. BMC Med. 2023;21(1):372. DOI:10.1186/s12916-023-03076-2
6. Marshall AG, Lee-Kubli C, Azmi S, et al. Spinal Disinhibition in Experimental and Clinical Painful Diabetic Neuropathy. Diabetes. 2017;66(5):1380-90. DOI:10.2337/db16-1181
7. Holmes CJ, Hastings MK. The Application of Exercise Training for Diabetic Peripheral Neuropathy. J Clin Med. 2021;10(21):5042. DOI:10.3390/jcm10215042
8. Price R, Smith D, Franklin G, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98(1):31-43. DOI:10.1212/WNL.0000000000013038
9. AlQuliti K. Predictors of painful diabetic neuropathy in Saudi patients with type 2 diabetes. J Pain Relief. 2015;4:181. DOI:10.4172/21670846.1000181
10. Abbott CA, Malik RA, van Ross ER, et al. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34(10):2220-4. DOI:10.2337/dc11-1108
11. Hébert HL, Veluchamy A, Torrance N, Smith BH. Risk factors for neuropathic pain in diabetes mellitus. Pain. 2017;158(4):560-8. DOI:10.1097/j.pain.0000000000000785
12. Abdissa D. Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center. J Diabetes Metab Disord. 2020;19(2):1407-13. DOI:10.1007/s40200-020-00661-7
13. Themistocleous AC, Ramirez JD, Shillo PR, et al. The Pain in Neuropathy Study (PiNS): a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy. Pain. 2016;157(5):1132-45. DOI:10.1097/j.pain.0000000000000491
14. Jambart S, Ammache Z, Haddad F, et al. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res. 2011;39(2):366-77. DOI:10.1177/147323001103900204
15. Ziegler D, Rathmann W, Meisinger C, et al Prevalence and risk factors of neuropathic pain in survivors of myocardial infarction with pre-diabetes and diabetes. The KORA Myocardial Infarction Registry. Eur J Pain. 2009;13(6):582-7. DOI:10.1016/j.ejpain.2008.07.007
16. 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
17. Yoo M, D’Silva LJ, Martin K, et al. Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy. Pain Med. 2015;16(8):1482-9. DOI:10.1111/pme.12743
18. Kluding PM, Pasnoor M, Singh R, et al. Safety of aerobic exercise in people with diabetic peripheral neuropathy: single-group clinical trial. Phys Ther. 2015;95(2):223-34. DOI:10.2522/ptj.20140108
19. Полуэктов М.Г., Головатюк А.О. Нарушения сна при острой и хронической боли. Неврология, нейропсихиатрия, психосоматика. 2021;13(3):125-30 [Poluektov MG, Golovatyuk AO. Sleep disorders in acute and chronic pain. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):125-30 (in Russian)]. DOI:10.14412/2074-2711-2021-3-125-130
20. Trauer JM, Qian MY, Doyle JS, et al. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(3):191-204. DOI:10.7326/M14-2841
21. Drake CL, Kalmbach DA, Arnedt JT, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019;42(2):zsy217. DOI:10.1093/sleep/zsy217
22. Головачева В.А., Головачева А.А., Голубев В.Л. Практические принципы лечения хронической неспецифической боли в нижней части спины и коморбидной хронической инсомнии: клиническое наблюдение. Медицинский совет. 2021;(10):164-70 [Golovacheva VA, Golovacheva AA, Golubev VL. Practical principles of treatment of chronic nonspecific pain in the lower back and comorbid chronic insomnia: clinical observation. Medical Council. 2021;(10):164-70 (in Russian)]. DOI:10.21518/2079-701X-2021-10-164-170
23. Головатюк А.О., Полуэктов М.Г. Эффективность дистанционных методов когнитивно-поведенческой терапии хронической инсомнии и возможности применения комбинированных подходов. Журнал неврологии и психиатрии им. С.С. Корсакова. Спецвыпуски. 2023;123(5‑2):58‑62 [Golovatyuk AO, Poluektov MG. The effectiveness of remote methods of cognitive behavioral therapy for chronic insomnia and the possibility of using combined approaches. Journal of Neurology and Psychiatry named after S.S. Korsakov. Special issues. 2023;123(5‑2):58‑62 (in Russian)]. DOI:10.17116/jnevro202312305258
24. D’Amato C, Morganti R, Greco C, et al. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res. 2016;13(6):418-28. DOI:10.1177/1479164116653240
25. Kec D, Rajdova A, Raputova J, et al. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study. Eur J Pain. 2022;26(2):370-89. DOI:10.1002/ejp.1865
26. Головачева В.А., Табеева Г.Р., Фатеева Т.Г. Ведение пациентов со скелетно-мышечной болью в спине и коморбидной тревогой. Медицинский Совет. 2022;(23):60-6 [Golovacheva VA, Tabeeva GR, Fateeva TG. Management of patients with musculoskeletal back pain and comorbid anxiety. Medical Council. 2022;(23):60-6 (in Russian)]. DOI:10.21518/2079-701X-2022-16-23-60-66
________________________________________________
1. International Diabetes Federation. 2024. Available at: https://idf.org/about-diabetes/diabetes-facts-figures/ Accessed: 15.05.2024.
2. Kirthi V, Perumbalath A, Brown E, et al. Prevalence of peripheral neuropathy in pre-diabetes: a systematic review. BMJ Open Diabetes Res Care. 2021;9(1):e002040. DOI:10.1136/bmjdrc-2020-002040
3. Pop-Busui R, Boulton AJ, Feldman EL, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54.
DOI:10.2337/dc16-2042
4. Callaghan BC, Gallagher G, Fridman V, Feldman EL. Diabetic neuropathy: what does the future hold? Diabetologia. 2020;63(5):891-7. DOI:10.1007/s00125-020-05085-9
5. Shi Y, Wu W. Multimodal non-invasive non-pharmacological therapies for chronic pain: mechanisms and progress. BMC Med. 2023;21(1):372. DOI:10.1186/s12916-023-03076-2
6. Marshall AG, Lee-Kubli C, Azmi S, et al. Spinal Disinhibition in Experimental and Clinical Painful Diabetic Neuropathy. Diabetes. 2017;66(5):1380-90. DOI:10.2337/db16-1181
7. Holmes CJ, Hastings MK. The Application of Exercise Training for Diabetic Peripheral Neuropathy. J Clin Med. 2021;10(21):5042. DOI:10.3390/jcm10215042
8. Price R, Smith D, Franklin G, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98(1):31-43. DOI:10.1212/WNL.0000000000013038
9. AlQuliti K. Predictors of painful diabetic neuropathy in Saudi patients with type 2 diabetes. J Pain Relief. 2015;4:181. DOI:10.4172/21670846.1000181
10. Abbott CA, Malik RA, van Ross ER, et al. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34(10):2220-4. DOI:10.2337/dc11-1108
11. Hébert HL, Veluchamy A, Torrance N, Smith BH. Risk factors for neuropathic pain in diabetes mellitus. Pain. 2017;158(4):560-8. DOI:10.1097/j.pain.0000000000000785
12. Abdissa D. Prevalence and associated factors of painful diabetic peripheral neuropathy among diabetic patients on follow up at Jimma University Medical Center. J Diabetes Metab Disord. 2020;19(2):1407-13. DOI:10.1007/s40200-020-00661-7
13. Themistocleous AC, Ramirez JD, Shillo PR, et al. The Pain in Neuropathy Study (PiNS): a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy. Pain. 2016;157(5):1132-45. DOI:10.1097/j.pain.0000000000000491
14. Jambart S, Ammache Z, Haddad F, et al. Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res. 2011;39(2):366-77. DOI:10.1177/147323001103900204
15. Ziegler D, Rathmann W, Meisinger C, et al Prevalence and risk factors of neuropathic pain in survivors of myocardial infarction with pre-diabetes and diabetes. The KORA Myocardial Infarction Registry. Eur J Pain. 2009;13(6):582-7. DOI:10.1016/j.ejpain.2008.07.007
16. 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
17. Yoo M, D’Silva LJ, Martin K, et al. Pilot Study of Exercise Therapy on Painful Diabetic Peripheral Neuropathy. Pain Med. 2015;16(8):1482-9. DOI:10.1111/pme.12743
18. Kluding PM, Pasnoor M, Singh R, et al. Safety of aerobic exercise in people with diabetic peripheral neuropathy: single-group clinical trial. Phys Ther. 2015;95(2):223-34. DOI:10.2522/ptj.20140108
19. Poluektov MG, Golovatyuk AO. Sleep disorders in acute and chronic pain. Neurology, Neuropsychiatry, Psychosomatics. 2021;13(3):125-30 (in Russian).
DOI:10.14412/2074-2711-2021-3-125-130
20. Trauer JM, Qian MY, Doyle JS, et al. Cognitive Behavioral Therapy for Chronic Insomnia: A Systematic Review and Meta-analysis. Ann Intern Med. 2015;163(3):191-204. DOI:10.7326/M14-2841
21. Drake CL, Kalmbach DA, Arnedt JT, et al. Treating chronic insomnia in postmenopausal women: a randomized clinical trial comparing cognitive-behavioral therapy for insomnia, sleep restriction therapy, and sleep hygiene education. Sleep. 2019;42(2):zsy217. DOI:10.1093/sleep/zsy217
22. Golovacheva VA, Golovacheva AA, Golubev VL. Practical principles of treatment of chronic nonspecific pain in the lower back and comorbid chronic insomnia: clinical observation. Medical Council. 2021;(10):164-70 (in Russian). DOI:10.21518/2079-701X-2021-10-164-170
23. Golovatyuk AO, Poluektov MG. The effectiveness of remote methods of cognitive behavioral therapy for chronic insomnia and the possibility of using combined approaches. Journal of Neurology and Psychiatry named after S.S. Korsakov. Special issues. 2023;123(5‑2):58‑62 (in Russian). DOI:10.17116/jnevro202312305258
24. D’Amato C, Morganti R, Greco C, et al. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res. 2016;13(6):418-28. DOI:10.1177/1479164116653240
25. Kec D, Rajdova A, Raputova J, et al. Risk factors for depression and anxiety in painful and painless diabetic polyneuropathy: A multicentre observational cross-sectional study. Eur J Pain. 2022;26(2):370-89. DOI:10.1002/ejp.1865
26. Golovacheva VA, Tabeeva GR, Fateeva TG. Management of patients with musculoskeletal back pain and comorbid anxiety. Medical Council. 2022;(23):60-6 (in Russian). DOI:10.21518/2079-701X-2022-16-23-60-66
Авторы
Е.В. Мандра*, А.Д. Ким
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*emandra97@mail.ru
ФГАОУ ВО «Первый Московский государственный медицинский университет им. И.М. Сеченова» Минздрава России (Сеченовский Университет), Москва, Россия
*emandra97@mail.ru
________________________________________________
Ekaterina V. Mandra*, Alina D. Kim
Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
*emandra97@mail.ru
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