AAN指南治疗痛性糖尿病神经病
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© 2011 AMERICAN ACADEMY OF NEUROLOGY
Background, cont.
• Pharmacologic Agents:
▪ Anticonvulsants, antidepressants, opioids, antiarrhythmics, cannabinoids, aldose reductase inhibitors, protein kinase C beta inhibitors, antioxidants (α-lipoic acid), transketolase activators (thiamines and allithiamines), topical medications (analgesic patches, anesthetic patches, capsaicin cream, clonidine), and others
• Nonpharmacologic Modalities:
▪ Infrared therapy, shoe magnets, exercise, acupuncture, external stimulation (transcutaneous electrical nerve stimulation), spinal cord stimulation, biofeedback and behavioral therapy, surgical decompression, and intrathecal baclofen
please contact guidelines@aan.com
© 2011 AMERICAN ACADEMY OF NEUROLOGY
Presentation Objectives
• To present analysis of the efficacy of pharmacologic and nonpharmacologic treatments to reduce pain and improve physical function and quality of life (QOL) in patients with painful diabetic neuropathy (PDN)
Bruce Perkins, MD, FRCP(C), MPH; James W. Russell, MD, MS, FRPC; Douglas Zochodne, MD
© 2011 ABaidu NhomakorabeaERICAN ACADEMY OF NEUROLOGY
If you have questions, comments, or feedback regarding this slide presentation, or would like to modify the contents for presentation in a lecture,
Vera Bril, MD, FRCP(C); John England, MD, FAAN; Gary M. Franklin, MD, MPH, FAAN; Miroslav Backonja, MD; Jeffrey Cohen, MD, FAAN; David Del Toro, MD; Eva Feldman, MD, PhD, FAAN; Donald J. Iverson, MD, FAAN;
Treatment of Painful Diabetic Neuropathy
Report of the American Academy of Neurology, the American Association of Neuromuscular and
Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation
• Many treatment options are available, and a rational approach to treating patients with PDN requires an understanding of the evidence for each intervention.
process • Analysis of evidence, conclusions, recommendations • Recommendations for future research
© 2011 AMERICAN ACADEMY OF NEUROLOGY
Background
• Diabetic sensorimotor polyneuropathy represents a diffuse symmetric and length-dependent injury to peripheral nerves that has major implications for QOL, morbidity, and cost from a public health perspective.1,2
• PDN affects 16% of patients with diabetes; it is frequently unreported (12.5%) and more frequently untreated (39%).3
• PDN presents an ongoing management problem for patients, caregivers, and physicians.
• To present evidence-based recommendations
© 2011 AMERICAN ACADEMY OF NEUROLOGY
Overview
• Background • Gaps in care • American Academy of Neurology (AAN) guideline
• This guideline addresses the efficacy of pharmacologic and nonpharmacologic treatments to reduce pain and improve physical function and QOL in patients with PDN.
Background, cont.
• Pharmacologic Agents:
▪ Anticonvulsants, antidepressants, opioids, antiarrhythmics, cannabinoids, aldose reductase inhibitors, protein kinase C beta inhibitors, antioxidants (α-lipoic acid), transketolase activators (thiamines and allithiamines), topical medications (analgesic patches, anesthetic patches, capsaicin cream, clonidine), and others
• Nonpharmacologic Modalities:
▪ Infrared therapy, shoe magnets, exercise, acupuncture, external stimulation (transcutaneous electrical nerve stimulation), spinal cord stimulation, biofeedback and behavioral therapy, surgical decompression, and intrathecal baclofen
please contact guidelines@aan.com
© 2011 AMERICAN ACADEMY OF NEUROLOGY
Presentation Objectives
• To present analysis of the efficacy of pharmacologic and nonpharmacologic treatments to reduce pain and improve physical function and quality of life (QOL) in patients with painful diabetic neuropathy (PDN)
Bruce Perkins, MD, FRCP(C), MPH; James W. Russell, MD, MS, FRPC; Douglas Zochodne, MD
© 2011 ABaidu NhomakorabeaERICAN ACADEMY OF NEUROLOGY
If you have questions, comments, or feedback regarding this slide presentation, or would like to modify the contents for presentation in a lecture,
Vera Bril, MD, FRCP(C); John England, MD, FAAN; Gary M. Franklin, MD, MPH, FAAN; Miroslav Backonja, MD; Jeffrey Cohen, MD, FAAN; David Del Toro, MD; Eva Feldman, MD, PhD, FAAN; Donald J. Iverson, MD, FAAN;
Treatment of Painful Diabetic Neuropathy
Report of the American Academy of Neurology, the American Association of Neuromuscular and
Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation
• Many treatment options are available, and a rational approach to treating patients with PDN requires an understanding of the evidence for each intervention.
process • Analysis of evidence, conclusions, recommendations • Recommendations for future research
© 2011 AMERICAN ACADEMY OF NEUROLOGY
Background
• Diabetic sensorimotor polyneuropathy represents a diffuse symmetric and length-dependent injury to peripheral nerves that has major implications for QOL, morbidity, and cost from a public health perspective.1,2
• PDN affects 16% of patients with diabetes; it is frequently unreported (12.5%) and more frequently untreated (39%).3
• PDN presents an ongoing management problem for patients, caregivers, and physicians.
• To present evidence-based recommendations
© 2011 AMERICAN ACADEMY OF NEUROLOGY
Overview
• Background • Gaps in care • American Academy of Neurology (AAN) guideline
• This guideline addresses the efficacy of pharmacologic and nonpharmacologic treatments to reduce pain and improve physical function and QOL in patients with PDN.