Health

What are the evidence based treatments of postherpetic neuralgia? There is a strong evidence base for treatment of PHN with tricyclics, pregabalin, and gabapentin. Unlike distal symmetric polyneuropathy, two topical agents have demonstrated benefit in this condition: Lidoderm patches (lidocaine in an adhesive patch), and high-potency (8%) capsaicin, which is applied once by a medical …

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What are the evidence based treatments of painful distal symmetric polyneuropathy and small fiber neuropathy? Nearly all evidence-based treatments are based upon studies performed in people with diabetic neuropathy. There is a strong evidence base for the efficacy of tricyclic agents (principally amitriptyline) pregabalin, gabapentin, and SNRIs (principally duloxetine). Some evidence also exists for efficacy …

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How is small fiber neuropathy different from painful distal symmetric polyneuropathy? Small fiber neuropathy is a term reserved for the circumstance in which distal symmetric painful polyneuropathy is largely restricted to small myelinated and unmyelinated axons. It is often the presenting form of painful polyneuropathy, with involvement of large myelinated axons developing later. Clinically it …

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What are the etiologies of distal symmetric painful polyneuropathy? • Diabetes is the most commonly established cause. While it is not clear why pain severity varies among people with diabetic neuropathy, evidence of some genetic factors is emerging. • There is also evidence that prediabetes (impaired glucose tolerance or impaired fasting glucose) is prevalent among nondiabetic people …

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How does distal symmetric painful polyneuropathy present clinically? Distal symmetric painful polyneuropathy presents with paresthesias or burning in the feet in a symmetric distribution. Because it is length-dependent, the symptoms usually begin in the toes and progress proximally. Foot pain beginning in the instep, heels, or ankles is less likely to be neuropathic. Symptoms are …

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What confirmatory tests are helpful in confirming the presence of a neuropathic pain condition? Pain is a clinical diagnosis, but in the following conditions testing can be useful in confirming the presence of a lesion of the somatosensory system and thus more clearly establish the case for a neuropathic pain diagnosis: • Painful distal symmetric polyneuropathy: While …

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How to examine a person with suspected neuropathic pain? The examination of a person in chronic pain should begin with an appropriate general physical examination of the affected area. Thus a musculoskeletal examination (visual inspection and palpation of the joints, range of motion testing, and firm palpation of tendons and fasciae for recognized musculoskeletal conditions, …

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