Peripheral neuropathic pain is a “medical emergency” that requires early diagnosis and treatment.
Underdiagnosis of peripheral neuropathic pain (PNP), the need for early detection and the importance of a multidisciplinary approach were some of the issues discussed at the Roundtable “Multidisciplinary Approach to Peripheral Neuropathic Pain” held recently. within the framework of the IV Congress of the Spanish Multidisciplinary Pain Society (SEMDOR) in collaboration with Grünenthal.
PND is a “medical emergency” and must be treated as soon as possible. Dr. Enrique del Coyo, anesthesiologist at the pain department of the Quirón Salud Hospital (Extremadura), described this pathology, which is based on pain caused by disease or damage to the peripheral somatosensory nervous system. In this sense, the doctor emphasized the need for early diagnosis in order to quickly carry out treatment and, in addition, that this treatment, if possible, should initially be minimally invasive, and also, if possible, avoid polypharmacy, “since, although” If the patient has no comorbidities, Tolerability of oral DNP treatment is generally difficult, and interventional treatment should be considered as a last resort.”
For her part, Dr. Maria Ara Bermejo, physician in the pain department of the University and Polytechnic Hospital of La Fe (Valencia), noted that peripheral neuropathic pain greatly affects the functionality and quality of life of people. At the same time, the profile of patients is diverse, since there are many reasons for the occurrence of this pathology. Damage to peripheral nerves can be the result of trauma, pinched nerves, systemic diseases (rheumatic, autoimmune, paraneoplastic, infectious, toxic-metabolic processes, etc.) and even medical-surgical treatment. Experts also emphasized that although there are large pharmacological families, treatments are not free from side effects: “In cancer patients, the neurotoxicity of chemotherapy may be the reason for dose reduction and treatment discontinuation, which compromises therapeutic efficacy and even.” survival,” emphasized Dr. Bermejo.
In this sense, Dr. del Coyo also emphasized that, along with the need to avoid underdiagnosis and use early diagnosis strategies, ensuring that treatment takes less time to be effective is another challenge for healthcare professionals in the world. approach to this pathology.
Moreover, some of the most frequently repeated treatments are highly invasive, such as infiltration, radiofrequency stimulation, neurostimulation, etc., but they are used as a first option to avoid polypharmacy in the patient, especially in the case of frail, elderly or previously received multi-drug medications. As an alternative, topical treatment such as capsaicin 179 mg patch is also used in these multi-medicated patients, the specialist said. “This treatment is one of the least invasive, it is effective, well tolerated, and it is even interesting to note that studies conducted in diabetic patients suffering from painful diabetic polyneuropathy raise a very plausible possibility regarding its ability to regenerate peripheral nerve transmission in these patients , which would theoretically help reduce the serious complications caused by this pathology, especially in the context of diabetic foot.”
The importance of an interdisciplinary approach for peripheral neuropathic pain
For her part, Dr. Maria Lia Nattero, endocrinologist at the Ramón y Cajal Hospital in Madrid, emphasized that endocrinology and nutrition specialists play an important role in the comprehensive treatment of painful diabetic polyneuropathy (PDNP), both in prevention and early detection. as well as in addressing its clinical manifestations: “Their participation is vital in the systematic screening of diabetic neuropathy, since this complication, often underdiagnosed in the initial stages, poses a high risk of progression towards painful and disabling forms.” In addition, the endocrinologist directly addresses modifiable risk factors for progression, especially in the control of glycemia, dyslipidemia, and blood pressure.
According to Dr. Nattero, one of the main challenges in diagnosing painful diabetic polyneuropathy is early detection, since the first symptoms can be subtle and underestimated by both patients and doctors, which delays the prognosis.
The specialist emphasizes the importance of a multidisciplinary approach to optimize both diagnosis and treatment: “This approach allows for more comprehensive monitoring of treatment side effects and adjustment of therapeutic strategies, facilitating safer and more effective management. Thus, it not only improves clinical outcomes, but also optimizes treatment adherence and patient satisfaction.”
Finally, the Round Table also emphasized that painful diabetic polyneuropathy is one of the most disabling and difficult to treat complications of diabetes, which has a great impact on the quality of life of patients at the physical and psychological level. “Some studies suggest that this pathology is associated with lower compliance with insulin therapy and glycemic control habits, which causes hyperglycemia and worsening neuropathy,” the endocrinologist concluded.