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Órgano Oficial de Difusión Científica de la Federación Mexicana de Colegios de Ortopedia y Traumatología, A.C. (FEMECOT)

2019, Number 3

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Ortho-tips 2019; 15 (3)

New perspectives on pain in the diabetic patient

Fernández FM

Language: Spanish
References: 49
Page: 171-184
PDF size: 324.35 Kb.


ABSTRACT

Pain in the diabetic patient was classically assigned to the peripheral polyneuropathy that these patients develop as part of their disease. It was, therefore, an undeniably neuropathic pain, and that has been considered for a long time. But as the pathophysiological and clinical knowledge of pain in general has deepened, the painful condition expressed in the diabetic has also undergone some fundamental changes. To the typically neuropathic pain of diabetic patients, with a double basis for demyelinating polyneuropathy and axonal loss, are added the painful manifestations secondary to local inflammatory phenomena, ischemia, mixed pain of concomitant arthropathies and sympathetic autonomic neuropathy. The spontaneous hyperactivity of the nociceptors, their various peripheral and central components, their chronicity and frequent inflammatory character must be considered. This pathogenic and clinical variability, recognizing that not all pain in diabetic patients shows a neuropathic component of pain and showing many of them non-neuropathic component of this, being mainly articular and/or vascular in a high proportion of cases, with secondary centralization. In fact, the character of pain in diabetic patients as mixed pain in multiple instances has already been signaled. Focusing in this diagnostic and therapeutic direction on pain in the diabetic patient we can improve expectations regarding improvement and quality of life in these patients.


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