21st February 2010 at 20:20 UTC by Dr.C.A.Jenner MB BS, FRCA, FFPMRCA. Permalink.
An overview of the use of duloxetene to treat diabetic neuropathic pain.
The use of duloxetene in the treatment of diabetic neuropathic pain, is quite a recent innovation, but early indicators are that it is a very effective treatment for this condition, with some studies showing that there is a 50% reduction in pain experienced by people with diabetic neuropathic pain. However, like other pain medications, duloxetine is no ‘magic bullet’ and whilst it may be useful for some patients, it is not a widespread panacea that will ensure that all the symptoms of diabetic neuropathy are ameliorated. Its use is therefore not appropriate for all.
Diabetic neuropathy is a generic term for any one of a nerve disorder that is caused primarily by diabetes. Over time, up to 70% of people who have diabetes will eventually develop some form of nerve damage.
The symptoms associated with diabetic neuropathy vary, with some people not feeling any outward symptoms and others feeling pain or numbness in their feet, legs, buttocks, arms and hands. Sometimes certain parts of the body may be more affected than others.
There is no one single cause of diabetic neuropathy, but many people develop it after they have had diabetes for a long time. It is also more prevalent in people who have struggled to control their blood sugar levels.
People with high blood pressure and high levels of fat in their blood, or people who are overweight/obese, will also be more likely to develop diabetic neuropathy.
Duloxetine is a very potent anti-depressant. It is also used in cases of severe anxiety. It is often referred to as an SNRI, this is because it is a ‘serotonin and norepinephrine re-uptake inhibitor’. This raises the levels of both serotonin and norepinephrine within the brain. These two substances occur naturally within the brain and are important for mental stability and they also help the brain recognising pain signals, which makes them effective in the use of diabetic neuropathy.
Duloxetine may not automatically be prescribed, simply because it is such a potent medication and as such may not be useful for everyone. Once duloxetine has been prescribed, close monitoring will take place to ensure that the dosage is appropriate and that there are no substantial side effects from taking this medication.
Critics of duloxetine argue that it only stops the brain receiving or recognising the pain signals, it does not actually cure the root cause of the diabetic neuropathy. However, for patients who have experienced diabetic neuropathy and who have been in considerable pain for some time, it can make a huge difference in terms of their quality of life. It is also quite efficient and pain relief can be achieved within the first week of starting the treatment.
Duloxetine may also interfere or interact with other medications, so again, its use cannot be universal. But when it can be used and it is safe to be prescribed, it can be a very good way of treating diabetic peripheral neuropathic pain and ensuring that quality of life is restored.
‘Duloxetene and Diabetic Neuropathic Pain’ was posted by Dr.C.A.Jenner MB BS, FRCA, FFPMRCA on 21st February 2010 at 20:20 UTC and filed under pending.
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