Pain associated with diabetic peripheral neuropathy: a review of available treatments.

cohol consumption, hypertension, hypercholesterolemia, and taller height (the longer the nerve fibers, the greater the susceptibility to damage from external trauma or vascular complications).1,3 Most practitioners are aware of the severe pain that accompanies DPN, but only 10% to 30% of patients experience painful symptoms. Instead, the disorder begins as a change in or loss of sensation that can be detected only by clinical tests. Symptoms associated with sensory loss are more common; these include an inability to feel, identify, or manipulate small objects; a loss of ability to judge temperature or painful stimuli; and muscle atrophy, which may lead to physical deformities.1 The pathophysiology of DPN is multifactorial (Figure 1).4 Increased oxidative stress, increased sorbitol, decreased nitric oxide, and increased homocysteine have been identified as the primary factors involved. Elevated blood glucose levels can lead to glycosylated proteins that are easily harmed by free radicals. These proteins may then combine with fats to produce advanced glycosylated end-products that have been linked to abnormalities in vascular tissue, lipid metabolism, and platelets.1,4 Increased sorbitol results from passive diffusion of glucose into nerve cells. After the glucose is inside the cell, it is converted to sorbitol (and other polyols). Sorbitol does not diffuse out of the cell very easily and thus accumulates within the neuron. Studies of diabetic rats suggest that nitric oxide deficiency After reviewing this article, readers should be able to: