Telehealth may increase access to specialists, improve patient compliance and reduce no-shows. Ease of scheduling is another advantage, depending on patient literacy.

This rapidly evolving healthcare delivery system may be innovative and convenient but involves many complexities. Some hurdles include regulation, evolving technology, reimbursement, limited access for low-income patients, and poor accessibility in remote areas. Also, telemedicine services are not for everyone. Many medical conditions still require in-person evaluations. However, some people with chronic long-term conditions may benefit from telehealth for in-between follow-ups.

The 2022 Florida Telehealth Forum took place on Sept. 23, 2022, at the NASA Kennedy Space Center. It gathered telehealth industry leaders who exposed on areas such as clinical practice, cybersecurity, and the legal perspective. They explained that cybersecurity attacks may pose threats to healthcare providers and patients alike.

Cyber threats may disrupt healthcare provision through loss of medical data, unauthorized disclosure of personal information, or software failures. The good news is that safeguards and security protocols are available so we can make the best use of this technology.

Information technology and computer systems have evolved to provide such safeguards. The provision of healthcare services has evolved over time in parallel. Noteworthily, space navigation has played a notable role. The fact that a telehealth forum took place at NASA facilities may have been a coincidence or not.

The origins of telemedicine are linked to our space and aeronautics history and to astronauts’ healthcare.

With more aerospace launches and upcoming missions, new medical advances could be expected and applied for general use.

Let’s go back in time. Since the 1960’s, NASA has been expanding its medical monitoring technology to determine human body function in space and the effects of spaceflight in the human body. Later, this translated into remote medical communications through “terrestrial analogs”. Remote American Indian communities in Arizona were the first to use NASA telemedicine technology. Similar projects followed in the 1980’s after natural disasters in Mexico and Armenia.

Nowadays, NASA continues to use telemedicine to monitor and diagnose astronauts. This has benefited the Apollo, Space Shuttle, and International Space Station programs, shaping the future of human space exploration.

Medical fields like cardiology have benefited from these initiatives. Tele-echocardiography is currently a reality. Specialized echocardiography technicians and paramedics can do this diagnostic test in remote areas. The information is sent to physicians in the bigger cities for interpretation and diagnosis. But this technology is further advanced in space. Microgravity may cause the astronauts’ hearts to atrophy. They may develop cardiac arrhythmias, heart blocks, and reduced exercise capacity.

The International Space Station has echocardiography machines operated by technicians on Earth through a robotic arm. The operator can be a healthcare provider that does not need to be an expert echocardiographer. The images can then be relayed to and analyzed by experts, who may interact with the operator during the procedure. This process simplifies cardiac evaluations without the need for specialists present in spacecrafts. Research efforts aim to further develop this system in space and on Earth.

Advanced understanding of both aeronautics and telehealth is ongoing.

The first International Conference in Aerospace Medicine took place in September 2022 in Paris, France, and included considerations about space medicine and cybersecurity and the potential use of artificial intelligence to provide care to remote communities on Earth and in space. It also featured a full presentation on the evolution of telemedicine in space, from the first space-to-Earth transmission via radio frequency in 1961 to the active provision of healthcare services to space crews at present times.

The recent Artemis I mission launch and the successful splashdown of the Orion spacecraft on December 11, 2022. opens the door for new advances as data analysis and preparations continue toward the launch of a crewed flight around the moon. It will be exciting to see how new missions in human space exploration further impact telehealth.

Telehealth continues to grow in unimaginable ways. Aerospace medicine has set the foundations and continues to innovate providing tools to the modern provision of telemedicine in Earth. However, telehealth providers must bear in mind that cyberthreats are a reality and should consider the need to implement policies to protect their data, and that of their patients, against attacks.

Contact me as your medical writer to assist with medical news articles and feature articles!

Telehealth: The Future is Here. From Cyber Threats to Aerospace Medicine

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Fibromyalgia is a syndrome characterized by widespread chronic pain. The main symptoms include pain, sleep dysfunction, fatigue, anxiety, depression, and impaired cognitive function.

Pain mainly involves muscles and joints, along with stiffness. But other areas may also be painful. For example, patients may have visceral pain.¹

Fibromyalgia can be associated with other conditions such as irritable bowel syndrome or diabetes. Also, with rheumatologic, neurological, or psychiatric diseases.²

Infections (such as Lyme disease, Epstein-Barr virus, and hepatitis), trauma, or psychological stress¹ may trigger the development of fibromyalgia.

The incidence is higher in women. Its usual onset is at 30 to 35 years old,² but it can develop at any age.¹

Diagnostic criteria

In 1990, the American College of Rheumatology (ACR) published the first official classification criteria for Fibromyalgia Syndrome (FMS).

The following criteria³ needed to be satisfied to make a diagnosis:

• History of generalized pain for at least 3 months:
  • In the axial skeleton
  • AND in at least 3 of the 4 body quadrants (left and right, above and below the waist).
• Pain in response to a pressure up to 4 kg/cm² in 11 of 18 specific body points.

Since then, several other methods of diagnosis have been proposed.^3,4

The ACR 2010 criteria use two scales:

• Widespread pain Index:
  • Considers the number of areas in which the patient has had pain over the past week, using a list of 19 painful areas.
• Symptom Severity Scale:
  • Rating severity of:
    • fatigue
    • waking unrefreshed
    • cognitive symptoms (like recognition memory, verbal knowledge, anxiety, and depression)
  • Rating of somatic symptoms (using a checklist of 41 symptoms including irritable bowel syndrome, fatigue, muscle weakness, etc.)

After the 2010 ACR criteria, there have been additional reviews and modifications. These modifications help facilitate its use in epidemiological studies.³

ACR 2015 statement about the ACR 2010 criteria:

In 2015, the ACR clarified that it had endorsed preliminary classification and diagnostic criteria. It was no longer considering endorsement of diagnostic criteria. Classification criteria are more useful for research and as teaching tools. Diagnostic criteria are more useful in the practice setting.⁵

There is still controversy on the assessment and diagnosis of Fibromyalgia Syndrome.

Many health professionals and patients still have concerns about how this disease is diagnosed. Despite the difficulties in diagnoses, some experts recommend that the assessment is not based on a diagnosis of exclusion.^3,4

In general, clinicians should use a multidimensional approach that considers the physical symptoms, psychosocial factors, and somatic complaints. However, basic laboratory tests can be done. Other pain disorders could be excluded as well,¹ since other conditions may coexist with fibromyalgia.

Pathophysiology

The pathophysiology of fibromyalgia syndrome is not well understood but appears to be related to how the brain processes pain. FMS is considered a central nervous system (CNS) augmentation syndrome. But there seems to be involvement of both the central and peripheral nervous systems.² It is believed that pain either originates or amplifies at the CNS.¹ This process is called centralized pain.

Central nervous system pathophysiological factors:

• Elevated levels of excitatory neurotransmitters: glutamate and substance P

• Reduced levels of serotonin and norepinephrine (at the descending inhibitory pathways of the spinal cord)

• Dopamine dysregulation

• Altered activity of the endogenous opioids

Findings favoring peripheral nervous system involvement:

• Peripheral sensitization may contribute to increased nociceptive signals in the spinal cord leading to central sensitization. 

• There might be a neuropathic pain component:
  • Reduced number of epidermal nerve fibers in skin biopsies.
  • Patients score higher on neuropathic pain questionnaires.

Autonomic nervous system abnormalities apparently contribute to the pathogenesis of this disease.²

Other pathophysiologic pathways implicated, although some with inconsistent results are:²

Inflammation. Inflammation is one of the suspects involved in FMS. Inflammatory cytokines and immune cells could be mediating this inflammation.²

Genetics. Genetic factors could be contributing to this multifactorial disease. Several candidate genes along with environmental factors could predispose patients to FMS.

Endocrine pathways. The hypothalamic-pituitary-adrenal endocrine axis could be involved in fibromyalgia patients. Stress plays a role in FMS. For that reason, cortisol levels have been studied in this population.²

Psychopathological disorders. The impairment in serotonin and norepinephrine neurotransmitters and the patient’s response to antidepressants favor the involvement of psycho-affective pathways in the pathogenesis of this disease.

Endogenous opioid pathways. The Mu-opioid receptor on B lymphocytes has been mentioned as a biomarker for fibromyalgia.

Sleep disorders. It has been suggested that sleep disorders are a manifestation of the disease and also a causative factor.²

Autoimmune factors. Autoimmunity seems to be linked to fibromyalgia. Several autoantibodies have been studied as possible biomarkers of the disease. A higher frequency of thyroid autoimmunity has been reported in fibromyalgia patients.

Free radicals. Research has proposed decreased antioxidant capabilities leading to oxidative stress and susceptibility to reactive oxygen species in fibromyalgia.

Role of obesity in Fibromyalgia Syndrome

More than half of fibromyalgia patients are obese or overweight.⁶ The mechanisms underlying the relationship between obesity and fibromyalgia are still unclear. A cross-sectional study of 2,339 fibromyalgia patients showed that obesity/overweight is associated with increased symptoms severity and functional impairment.⁶

Pharmacologic Treatment

Not many drugs have been approved for the treatment of FMS. Pain relief is limited in part because many patients have side effects or do not benefit from drug treatment.⁴ The medication selection should be based on the predominant symptoms, such as sleep disturbance, pain, anxiety, or depression.

The FDA has approved duloxetine, milnacipran, and pregabalin for the treatment of FMS. In the clinical setting, several other medications are also used.

Drug classes used for FMS include:

Gabapentinoids

Pregabalin is one of the principal drugs used in the treatment of FMS. It is FDA-approved for FMS.  It is a gamma-aminobutyric acid (GABA) analog and is a ligand for the alpha 2 delta subunit of the calcium channel.⁴

Gabapentin is also a GABA analog and is often used off-label for FMS.

Serotonin–Norepinephrine Reuptake Inhibitors (SNRIs)

Clinicians use the SNRIs desvenlafaxine, venlafaxine, duloxetine, and milnacipran for FMS. Of those, duloxetine and milnacipran are FDA-approved for fibromyalgia. 

Tricyclic antidepressants (TCAs)

Amitriptyline has been widely used for years in the treatment of FMS.

Serotonin selective reuptake inhibitors (SSRIs)

No SSRIs are FDA-approved for FMS. 

Other antidepressants

Mirtazapine is also mentioned in the literature for the treatment of fibromyalgia. 

Opioids

The long-term use of opioids for the treatment of FMS is discouraged. However, for intractable pain, tramadol has been recommended. Besides being considered an opioid receptor agonist, it also shows serotonin-norepinephrine reuptake inhibitor properties.⁴

Low dose naltrexone

This opioid receptor antagonist is being used off-label for the treatment of fibromyalgia and continues to be under study.⁷

Supplements

Melatonin, vitamin D, and Coenzyme Q10 have been studied in association with FMS and could be considered as potential complements to treatment.

Magnesium is one of the most commonly used supplements in FMS, although its role in this disease is still uncertain.⁸

Diet

Some studies have indicated an improvement in quality of life, body weight, pain, sleep quality, psychological disturbances, and general health in patients with FMS on mainly vegetarian or vegan plant-based diets. These diets consist mainly of vegetables, fruits, nuts and seeds, mushrooms, legumes, and whole grains.⁹

Nonpharmacological Treatment

A multidisciplinary approach is recommended. It should include a combination of the following interventions:

Patient education with an emphasis on stress reduction, exercise, and sleep¹

Cognitive-behavioral therapy

Exercise

Pharmacotherapy

Pain management

Natural remedies can be added if safe and tolerated.

Exercise

Aerobic exercise

A meta-analysis and systematic review from 2010 showed that aerobic exercise reduces pain, fatigue, and depressed mood. It also improves health-related quality of life and physical fitness. Continuity is necessary to maintain its positive effects.¹⁰

This article proposed specific recommendations for exercise. An exercise protocol for patients with fibromyalgia may be as follow for a reduction of symptoms:

-Modality: water-based or land-based

-Intensity: slight to moderate

-Frequency: 2 to 3 times per week

-Duration: 4 to 6 weeks

According to a more recent Cochrane Review from 2017, aerobic exercise probably improves health-related quality of life in FMS. It may slightly decrease pain and stiffness while improving physical and cardiorespiratory function in adults with fibromyalgia. Based on this review, aerobic exercises seem to be well tolerated and may be integrated into treatment. Patients may be able to walk without exacerbating symptoms.¹¹

Resistance Exercise

Not many studies have evaluated the effects of resistance exercise in FMS. A randomized controlled trial¹² showed that a supervised progressive resistance exercise program could be feasible for women with FMS. In this study, there was an improvement in muscle function, health status, and pain intensity at the end of the intervention.

Flexibility exercise

There is not enough quality scientific data about flexibility exercise in fibromyalgia patients. No specific recommendations for flexibility exercise protocols have been made.¹³

Physical therapy modalities

Many physical therapy modalities can be used for pain in a variety of medical conditions. Physical therapy modalities, including cold packs, heating pads, electrical stimulation and myofascial release, are used in the clinical setting for pain and muscle spasms in general.

Literature specific for the treatment of fibromyalgia with these modalities is scant.

Myofascial release has moderately shown to be effective for improving pain, fatigue, stiffness, anxiety, depression, and quality of life of people with FMS.¹⁴

TENS (transcutaneous electrical nerve stimulation) may be effective for pain relief in FMS, based on low-quality evidence. Electroacupuncture shows a moderate level of evidence for relieving pain.¹⁴

Aquatic therapy seems to produce a mild improvement in pain and quality of life in patients with FMS.¹⁴

Alternative treatments

Some of the alternative therapies that have been studied for fibromyalgia are:

Body warming

Cryotherapy

Mud-bath treatment

Hyperbaric Oxygen Therapy

Laser Therapy and Phototherapy

Vibroacoustic and Rhythmic Sensory Stimulation

Dancing

Zumba

Mind-body approaches

Probiotics

Plant extracts such as Commiphora myrrha and Hypericum perforatum (St.John’s wort) have been investigated in pre-clinical trials. Crocus sativus (saffron) extract has also been studied.⁴

Most therapies in the list above are controversial and not used in the clinical setting.

In Conclusion

Fibromyalgia syndrome diagnosis continues to be controversial and is still in debate. Treatment should be done in a multidisciplinary fashion. Several pharmacologic options are used in the clinical setting. Three medications are FDA-approved for this condition. Patient education, cognitive-behavioral therapy, and exercise are the principal tools to manage this disease. Additional research is needed to clarify its pathogenesis and delineate precise treatment protocols.

REFERENCES

1. Clauw DJ. Fibromyalgia: a clinical review. JAMA. 2014;311(15):1547-1555. doi:10.1001/jama.2014.3266
2. Siracusa R, Paola RD, Cuzzocrea S, Impellizzeri D. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int J Mol Sci. 2021;22(8):3891. Published 2021 Apr 9. doi:10.3390/ijms22083891
3. Galvez-Sánchez CM, Reyes Del Paso GA. Diagnostic Criteria for Fibromyalgia: Critical Review and Future Perspectives. J Clin Med. 2020;9(4):1219. Published 2020 Apr 23. doi:10.3390/jcm9041219
4. Maffei ME. Fibromyalgia: Recent Advances in Diagnosis, Classification, Pharmacotherapy and Alternative Remedies. Int J Mol Sci. 2020;21(21):7877. Published 2020 Oct 23. doi:10.3390/ijms21217877
5. Aggarwal R, Ringold S, Khanna D, et al. Distinctions between diagnostic and classification criteria?. Arthritis Care Res (Hoboken). 2015;67(7):891-897. doi:10.1002/acr.22583
6. Atzeni F, Alciati A, Salaffi F, et al. The association between body mass index and fibromyalgia severity: data from a cross-sectional survey of 2339 patients. Rheumatol Adv Pract. 2021;5(1):rkab015. Published 2021 Mar 1. doi:10.1093/rap/rkab015
7. Bruun KD, Amris K, Vaegter HB, et al. Low-dose naltrexone for the treatment of fibromyalgia: protocol for a double-blind, randomized, placebo-controlled trial. Trials. 2021;22(1):804. Published 2021 Nov 15. doi:10.1186/s13063-021-05776-7
8. Boulis M, Boulis M, Clauw D. Magnesium and Fibromyalgia: A Literature Review. J Prim Care Community Health. 2021;12:21501327211038433. doi:10.1177/21501327211038433
9. Nadal-Nicolás Y, Miralles-Amorós L, Martínez-Olcina M, Sánchez-Ortega M, Mora J, Martínez-Rodríguez A. Vegetarian and Vegan Diet in Fibromyalgia: A Systematic Review. Int J Environ Res Public Health. 2021;18(9):4955. Published 2021 May 6. doi:10.3390/ijerph18094955
10. Häuser et al. Efficacy of different types of aerobic exercise in fibromyalgia syndrome: a systematic review and meta-analysis of randomised controlled trials. Arthritis Research & Therapy 2010, 12:R79. http://arthritis-research.com/content/12/3/R79
11. Bidonde J, Busch AJ, Schachter CL, Overend TJ, KimSY, Góes SM, Boden C, Foulds HJA. Aerobic exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews 2017, Issue 6. Art. No.: CD012700. doi: 10.1002/14651858.CD012700.
12. Larsson A, Palstam A, Löfgren M, et al. Resistance exercise improves muscle strength, health status and pain intensity in fibromyalgia–a randomized controlled trial. Arthritis Res Ther. 2015;17(1):161. Published 2015 Jun 18. doi:10.1186/s13075-015-0679-1
13. Kim_SY, Busch_AJ, Overend_TJ, Schachter_CL, van der Spuy_I, Boden_C, Góes_SM, Foulds_HJA, Bidonde_J. Flexibility exercise training for adults with fibromyalgia. Cochrane Database of Systematic Reviews 2019, Issue 9. Art. No.: CD013419. doi: 10.1002/14651858.CD013419.
14. Araújo FM, DeSantana JM. Physical therapy modalities for treating fibromyalgia. F1000Res. 2019;8:F1000 Faculty Rev-2030. Published 2019 Nov 29. doi:10.12688/f1000research.17176.1
15. Cuyul-Vásquez I, Araya-Quintanilla F, Gutiérrez-Espinoza H. Comment on Siracusa et al. Fibromyalgia: Pathogenesis, Mechanisms, Diagnosis and Treatment Options Update. Int. J. Mol. Sci. 2021, 22, 3891. Int J Mol Sci. 2021;22(16):9075. Published 2021 Aug 23. doi:10.3390/ijms22169075

Fibromyalgia Overview: Controversies and Complexities of Diagnosis and Management

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Osteoporosis is a disease characterized by loss of bone mass and deterioration of the bone architecture. This means that the quantity and quality of the bone gets compromised. This bone disorder leads to a reduction in bone strength predisposing a person to an increased risk of fractures¹.  

Osteoporosis is common

More than 10 million people were estimated to have osteoporosis in the United States in 2010. About 12.6% of adults 50 years and older in the United States had osteoporosis by 2017-2018². The percentage of people with low bone mass, a precursor for osteoporosis, was even higher.

Osteoporosis is asymptomatic.

This condition does not present with symptoms and usually remains undiagnosed until the patient comes to medical attention due to a fracture^1,3. These fractures generally occur after minor events not expected to break the bones. For this reason, they are called fragility fractures.

Fragility fractures and their consequences. 

Osteoporotic fractures commonly occur in the vertebrae, hips, wrists, and upper arms⁴. Vertebral compression fractures are the most common osteoporotic fractures. These may result in chronic back pain and limited mobility⁴. Hip fractures have the most serious outcomes and may be disabling and deadly^1-,4.

Risk factors for osteoporosis

Some of the most common risk factors for the development of osteoporosis include:

• Older age.
• Being a woman: due to having smaller bones and a higher tendency to fall. The risk is higher after menopause due to loss of estrogen.
• Race: Caucasians have a higher risk of osteoporosis.
• Smoking and drinking alcohol.
• History of a prior fracture.
• Low body weight
• Poor nutrition: causing decreased body weight, calcium and vitamin D deficiency, among other problems.
• Having other medical conditions (or secondary causes) may increase the risk of osteoporosis. Some examples of secondary causes include: hyperthyroidism, gastrointestinal malabsorption, bariatric surgery, inflammatory bowel disease, organ transplantation, rheumatoid arthritis, use of certain medications (such as: glucocorticoids, anticonvulsants and antidepressants among others).

How the bone gets weak?

Bones provide a structure for the body. Besides protecting other organs, the bone is an organ in itself. It provides storage for minerals like calcium and phosphorous, which in turn are essential for bone stability. The bone is continuously undergoing remodeling. It is reabsorbed by cells called osteoclasts and new bone is formed by cells called osteoblasts. This process of bone remodeling is regulated by many other factors such as: parathyroid hormone, estrogen, vitamin D, glucocorticoids and thyroid hormone. An imbalance in this process may result in osteoporosis. A classic example would be the loss of estrogen that occurs at menopause, leading to bone resorption and weakness.

How is osteoporosis diagnosed?

• The diagnosis is primarily made through a bone density scan or DEXA Scan (dual-energy x-ray absorptiometry).

• There is no laboratory testing to assess directly for osteoporosis, but testing should be done to look for other problems that may cause osteoporosis. Laboratory tests suggested include:
  • Vitamin D levels
  • Calcium levels in blood and urine
  • Parathyroid hormone (PTH)
  • Thyroid stimulating hormone (TSH)

How to improve bone mass?

Regular weight-bearing exercises should help with this goal. The resistance exercise should provide a sufficient amount of pull or tension to the bone. This strain to the bone will help build bone mass.

Besides strengthening exercises, an exercise program for osteoporosis should include balance training and fall prevention⁵. A fall prevention program should include a home evaluation and the possible use of assistive devices such as a cane or walker.

Vitamin D deficiency should be corrected to help in the bone remodeling process, muscle strength and balance.

What is the treatment for osteoporosis?

Lifestyle changes are essential to increase muscle mass and reduce the risk of falls.  Some of the lifestyle recommendations include:

• Regular weight bearing exercise.
• No smoking or drinking alcohol.
• Dietary changes that include an adequate consumption of calcium and vitamin D.  Spending time in the sun can also help increase the levels of vitamin D. Sun exposure should be done in moderation to limit the risk of developing skin cancer.

Several medications are available as treatment options for osteoporosis. A class of drugs called bisphosphonates is the first-line choice for most patients³. Bisphosphonates inhibit the bone resorption by the osteoclasts leading to a gain in bone mass.

The bisphosphonates are the first line option for the treatment for:

• postmenopausal women
• men
• osteoporosis caused by glucocorticoids

The most commonly used bisphosphonates are:

• Alendronate
• Risendronate
• Zolendronic acid (which is administered intravenously)

The duration of treatment varies. Five years of treatment is enough for most postmenopausal women. In general, after a few years of treatment, the doctor could recommend a drug holiday or a treatment interruption for some time.

Other drug choices

There are many other treatment options available for select patients.  Certain patients could benefit from:

• Denosumab
• Hormonal therapies such as raloxifene, conjugated estrogens with badezofixene, estrogen-progestin, testosterone.
• Calcitonin
• Drugs similar to the parathyroid hormone such as: teriparatide and abaloparatide

To keep in mind

Osteoporosis causes loss of bone mass and an increased risk of fractures. It does not present with any symptoms, for which screening and prevention are necessary. Some simple interventions may help strengthen the bones, like eating a healthy diet and engaging in regular weight-bearing exercise. There are several treatment options available that should be individualized to the patient’s characteristics and needs.

REFERENCES:

1. Lorentzon M, Cummings SR. Osteoporosis: the evolution of a diagnosis. J Intern Med. 2015;277(6):650-661.  doi:10.1111/joim.12369
2. Sarafrazi N, Wambogo EA, Shepherd JA. Osteoporosis or low bone mass in older adults: United States, 2017–2018.  NCHS Data Brief, no 405. Hyattsville, MD: National Center for Health Statistics. 2021. doi:    https://dx.doi.org/10.15620/cdc:103477
3. Tu KN, Lie JD, Wan CKV, et al. Osteoporosis: A Review of Treatment Options. P T. 2018;43(2):92-104.
4. Kasturi GC, Cifu DX, Adler RA. A review of osteoporosis: part I. Impact, pathophysiology, diagnosis and unique   role of the physiatrist. PMR. 2009;1(3):254-260. doi:10.1016/j.pmrj.2008.12.005
5. Kasturi GC, Adler RA. Osteoporosis: nonpharmacologic management. PMR. 2011;3(6):562-572.doi:10.1016/j.pmrj.2010.12.014

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Diabetic neuropathy is an impairment of the nerve terminal that is frequently seen in people with diabetes or prediabetes. Diabetes may cause several types of damage to the nervous system. The most common type of nerve injury occurs in a “stocking-glove” distribution. Here we will discuss this pattern of nerve injury, which is most commonly called diabetic neuropathy.

What are the symptoms of diabetic neuropathy?

Some of the most common symptoms of diabetic neuropathy include:

• Pain
• Burning sensation
• Numbness
• Tingling
• Pins and Needles sensation

The symptoms are most commonly noticed in the feet but may go up the legs and hands. Some patients may develop loss of balance or muscle weakness if the neuropathy is severe or affects the motor nerve fibers.

What are the possible complications of diabetic neuropathy?

• Skin ulcers in the feet due to diminished sensation
• Infected skin ulcers, which may result in lower limb amputations
• Chronic pain
• Decreased balance leading to falls

How is diabetic neuropathy diagnosed?

How is diabetic neuropathy treated?

A strict control of the blood glucose levels is essential in the treatment of diabetic neuropathy. An adequate diet and regular exercise are recommended to help control the blood sugar levels. The evaluation and treatment of any other co-existing conditions (such as high cholesterol levels) is also advised. These lifestyle changes should be complemented by avoiding the use of alcohol and cigarette.

The other aspect to consider is pain control. There are different classes of medications that can be used for the management of diabetic neuropathic pain. Treatment options may include:

• Pregabalin
• Duloxetine
• Gabapentin
• Opioids such as Tapendalol (beware of addiction potential).
• Other options such as Capsaicin cream and Lidocaine patches.

Physical measures might help with the relief of pain, such as receiving transcutaneous electrical nerve stimulation (TENS). If there are balance problems or frequent falls, physical therapy could be helpful.

It is important to inspect the skin of the feet regularly and to wear adequate shoes and socks.

Bottom Line

Diabetic neuropathy is a nerve terminal impairment that occurs in people with diabetes or prediabetes. Early detection and treatment of elevated blood glucose levels are crucial for the prevention and management of diabetic neuropathy. There are several treatment options available to address the neuropathic pain. Lifestyle changes and foot care are essential to avoid any further complications.

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