2023-11-14 09:28:57
Good diabetes control, key to avoiding painful diabetic neuropathy
Painful diabetic neuropathy is a complication of type 2 diabetes, the most common, when it is not well controlled.
Type 2 diabetes affects more than 90 percent of people with this disease, which commemorates its World Day on November 14.
There are more than 460 million people with diabetes in the world, with a forecast of 578 million in 2030 and 700 million in 2045, a true epidemic, experts warn.
In Spain there are around 6 million people with diabetes, approximately 14 percent of the population.
Painful diabetic neuropathy affects approximately 25 percent of people with diabetes. It is generally vascular in cause and causes damage to the primary sensory nerves. Its onset can be bilateral in the fingers and feet, and it can gradually progress to the calves and knees.
The pain it produces is described with terms such as irritating, stabbing, persistent and deep. Consequences of this pain can be depression, anxiety and sleep disorders. The intensity of neuropathic pain usually worsens at night.
“Your medications”the video blog that EFEsalud and the Viatris Foundation for Health jointly promote and improve therapeutic adherence, has brought together a doctor specializing in pain and a patient representative at the headquarters of the Viatris Foundation to discuss painful diabetic neuropathy and give visibility to this ailment.
Dr. María Madariaga, president of the Spanish Pain Society, in “Your medications”/EFE/Javier Tejedo/Pedro Gago
Two experts discuss painful diabetic neuropathy
The doctor is Maria Madariagaanesthesiologist and president of the Spanish Pain Society (SED), and on behalf of the patients he has intervened Juan Francisco Perán, president of the Spanish Diabetes Federation (FEDE).
Doctor Madariaga: trust in doctors, treatments and research
Dr. Madariaga, what is painful diabetic neuropathy?
Painful diabetic polyneuropathy is a complication of poorly controlled diabetes. It consists of the accumulation of a series of metabolites in the peripheral nerves, the finest nerves in our anatomy, which are found throughout our body, and are responsible for conveying tactile sensitivity.
It can affect and limit the perception of touch and, in the most serious cases, cause pain.
That is why it is so important, since diabetes is very prevalent, that all patients are warned of this possibility and avoid poor long-term diabetes control.
How does this pathology affect and how does it hurt?
It does not start manifesting with pain. The initial symptoms are not pain, but lack of sensitivity, swelling, mainly in the feet, which is where it starts, and progressively upwards. It also appears on the hands, and I insist that initially the symptoms are very subtle; cramps and painful sensation appear later.
How is this pain controlled and what are its treatments?
It is not a usual or conventional pain; It is called neuropathic pain because it is an injury to the nervous system, which is why it is difficult to treat.
The treatment is based on conventional analgesics, more or less powerful, and there is also a group of drugs that we call adjuvants that basically belong to two types: antiepileptics and antidepressants, which help control the intensity of pain, although not completely, which is why it is so important to associate them at minimally tolerable doses for the patient along with conventional analgesics to optimize control.
How important is therapeutic adherence, what is its degree of compliance and how can it be improved?
The most important thing when it comes to therapeutic compliance is that patients are aware that the key is to reduce or normalize blood glucose levels and treat diabetes scrupulously: do not skip treatments or physical exercise, and do not make dietary transgressions.
To prevent high blood sugar levels, diabetes therapeutic compliance is essential and, if neuropathic pain appears, follow the prescribed therapies.
Therefore, I insist, comply with the diabetes treatment to prevent and control neuropathic pain if it appears, always in consultation with the medical team to find the appropriate medications and readjust the treatments if necessary, with the aim of maintaining the quality of life, which is what it’s all about.
Doctor, what message do you convey as a pain specialist to people affected by painful diabetic neuropathy?
A message of hope. Currently there are many treatments and much research into new therapeutic targets. And a message of trust in your medical teams and communication with them. It is important not to silence the pain.
A message of hope and also of self-perception, being aware that if things don’t work, you have to talk to the doctors again, readjust the treatment and not settle.
Pain medicine advances every day and we have efficient and effective devices to treat it and improve quality of life.
Juan Francisco Perán, president of the Spanish Diabetes Federation, in “Your medications”/EFE/Javier Tejedo/Pedro Gago
Juan Francisco Perán: Training and education in diabetes is needed
What is the pain of diabetic neuropathy like and how does it affect the quality of life of patients?
The pain presents itself in different ways, but there is a prelude, it begins with a swelling or numbness of the extremities, and then the pain appears, which manifests itself as stinging, burning, burning, muscle weakness that limits mobility.
To get an idea, it is compared by saying that you cannot resist the pain when lying down if you rub against the sheet.
And it affects personal life, both in mobility and on a psychological level.
How important is therapeutic adherence to combat this pain?
Adherence to treatment is everything. But what I emphasize is that the patient maintains optimal control of his diabetes, a normoglycemia, and for this he needs adequate training, diabetes education, which should be given before the pathology appears.
Diabetes patients are treated in Primary Care and at FEDE it is something we denounce. Type 2 patients, who suffer from this pathology, lack expert diabetes educators in primary school.
What do patients who suffer from this pathology need and do not have?
Have access to specialists, endocrinologists, neurologists, health professionals who know how to advise and guide them; access to the most innovative treatments, but I insist on the lack of diabetes education, which is what causes neuropathic pain to appear and can worsen.
The Public Administration must be made aware of the need in Primary Care for the implementation of expert diabetes educators in health centers, such as expert nurses.
And the role of patient associations to improve therapeutic adherence?
It has been shown that the exchange of experiences between people who suffer from the same pathology significantly improves patients’ adherence to treatment.
For example, in treatments such as going for a walk, doing it alone is not the same as being accompanied and, logically, an expert patient who is well controlled and who manages his diabetes well, will accompany another in the complications that he encounters throughout. of the day.
Patient associations carry out countless activities to promote diabetes education, nutrition, and physical exercise. As president of WEDDING RINGI encourage all people with type 2 diabetes to go to the nearest association because they will help you.
From left To the right, Carlota Castañeda, from the Viatris Foundation for Health; Juan Francisco Perán, president of the Spanish Diabetes Federation; Javier Tovar, director of EFEsalud; Dr. María Madariaga, president of the Spanish Pain Society; and Javier Anitua, director of the Viatris Foundation for Health/EFE/Javier Tejedo/Pedro Gago
EFEsalud and the Viatris Foundation They maintain their common goal of raising awareness in society about the importance of taking medications correctly and improving levels of therapeutic adherence..
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