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Diabetic Peripheral Neuropathy


neuropathy

Diabetics may develop this condition after uncontrolled diabetes over a long term. Symptoms score include stabbing pain, burning pain, paresthesia, and asleep numbness.

Alpha-lipoic acid and diabetic peripheral neuropathy:

There is evidence to suggest that alpha-lipoic acid (ALA), an antioxidant, reduces neuropathic pain in patients with diabetes. Participants in a study were randomized to IV administration of either ALA (600 mg) (n = 60) or placebo (n = 60) for 5 days/week for a total of 14 treatments. At the end of the study, the total symptom score in patients taking ALA had improved by an average of 4.8 points, compared to an improvement of only 1.8 points in the placebo group. Compared to the placebo group, the treatment group had evidence of significant improvement in pain, numbness while asleep, prickling, neuropathy signs, and overall measure of effectiveness. (20)

In a double-blind, placebo-controlled trial,181 patients with diabetic peripheral neuropathy were given either placebo or one of 3 doses of lipoic acid: 600, 1200 or 1800 mg daily. Over the five week study period, benefits were seen in all three lipoic acid groups as compared to the placebo group. Average total symptom score (TSS) (including stabbing pain, burning pain, paresthesia, and asleep numbness of the feet) improved by 51% in ALA600, 48% in ALA1200, and 52% in ALA1800 compared with just 32% in the placebo group. Rates for those experiencing a 50% or more reduction in TSS was 62% (ALA600), 50% (ALA1200), 56% (ALA1800), and 26% (placebo). Participants experienced increased symptoms of nausea, vomiting, and vertigo as the dose of ALA increased. (21)

A review of studies found that among diabetes patients with peripheral neuropathy, a problem with the nerves that can produce pain, loss of sensation, and an inability to control muscles, alpha lipoic acid was found to significantly reduce neuropathic pain. Alpha lipoic acid, a fatty acid, is also an antioxidant found naturally inside every cell in the body. It’s needed by the body to produce the energy for the body’s normal functions. Researchers found that alpha lipoic acid was associated with an average total symptom scores reduction of 2.26. Specifically, when given orally the reduction was 1.78 and when administered by IV the reduction increased to 2.81. There is also evidence that alpha lipoic acid decreases neuropathic pain when given for a period of 3 weeks at a dose of 600 mg/day (grade of recommendation A). However, it is unclear whether the benefits seen after the oral administration of alpha lipoic acid over 3-5 weeks at a dose of  >600 mg/day are clinically relevant. (22)

A meta-analysis of 15 randomized controlled trials found that IV administration of 300-600 mg/day α-lipoic acid (ALA) for 2-4 weeks for treatment of diabetic peripheral neuropathy (DPN), a problem with the nerves that can produce pain, loss of sensation, and an inability to control muscles, was associated with a significant improvement in nerve conduction velocity and neuropathic symptoms. ALA was associated with an average benefit for median motor nerve conduction velocity (MNCV) of 4.63, median sensory nerve conduction velocity (SNCV) of 3.17, for peroneal MNCV, 4.25, and 3.65 for peroneal SNCV. (23)

 

Capsaicin and peripheral neuropathy:

In a study by Anand et al, a topical skin patch with 8% capsaicin placed for 1 hour was successful at producing pain relief at the site of peripheral neuropathy for up to 12 weeks. The mechanism of action was proposed to be defunctionalized peripheral nerve function. There was determined to be a low risk of both adverse systemic reaction and drug interactions. (46)

A review of studies on the use of capsaicin cream for pain relief was conducted. Six studies (n=389) were identified examining low dose (0.075%) capsaicin cream versus placebo. Low dose topical capsaicin was ineffective for pain without significant effect beyond placebo. Studies showed skin reactions could result in withdrawal and were more common with capsaicin than placebo though this became better with time. Adverse effects were rare systemically. (47)

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