Treatment

This is difficult, but above all, the promise that the symptoms always eventually remit may sustain patients during the wretched months of their illness. It sometimes helps for them to meet a patient who has already recovered from neuropathic pain. Diabetic control should be optimal, and insulin should be given if necessary. Initially, simple analgesics such as paracetamol taken regularly should be tried. Tricyclic antidepressants have a specific effect in the management of neuropathic pain and are valuable in this condition: a useful combination is a preparation containing a phenothiazine (fluphenazine) with nortryptiline (Motival). Gabapentin is effective and carbamazepine may help. Capsaicin cream may have a small effect after itself causing some initial discomfort. Topiramate may be used for limited periods in those with severe and protracted pain. Drugs of addiction should be avoided although just occasionally and for a short period an opioid derivative can be used at bedtime to help distressed patients to sleep.

Application of Opsite (a thin adhesive film) can help alleviate contact discomfort. Electrical nerve stimulators applied to the site of pain may help, and patients can then take an active part in their treatment.

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Diabetic radiculopathy area of exquisite contact sensitivity can easily and reproducibly be traced with a finger—shown in red

Diabetic radiculopathy area of exquisite contact sensitivity can easily and reproducibly be traced with a finger—shown in red

Bulging of the abdominal wall in a patient with truncal radiculopathy

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12

16

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24

28

32

Normal weight 85kg

Neuritic episode

Moderate symptoms

Residual symptoms

Severe

symptoms

1 1 Insulin

1 1 Diet and oral hypoglycaemic agents

Months

Progression of acute painful neuropathy

Diabetes 2

Diabetes 2

Diabetes is a disease that affects the way your body uses food. Normally, your body converts sugars, starches and other foods into a form of sugar called glucose. Your body uses glucose for fuel. The cells receive the glucose through the bloodstream. They then use insulin a hormone made by the pancreas to absorb the glucose, convert it into energy, and either use it or store it for later use. Learn more...

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