Painful diabetic neuropathy succesfully treated with medication
A 69 year old lay was seen in the clinic who presented with a 10 year history of pain affecting her upper arms, which she described as deep bone pain, present all the time and she felt her symptoms were getting progressively worse.
Diagnosis of painful small fibre neuropathy secondary to diabetes
She had been under different Pain Clinics and other specialists for a number of years and had more recently been diagnosed with small fibre neuropathy, secondary to her type 2 diabetes.
Examination findings in painful diabetic neuropathy
Her past history included hypertension, hypercholesterolaemia and type 2 diabetes and she was taking Perindopril, Dihydrocodeine and Atorvastatin. When she was seen in the Pain Clinic, on examination she had widespread pain on pin prick sensation (hyperalgesia) in the lower limbs, especially below the knees, but no pain on light touch (allodynia). However, she did report that she is very hypersensitive to cold air and touch, and she described the pain as a burning-like pain with a dead feeling in the middle of the bones. I note she has been on a number of medications previously but had suffered from adverse effects from these.
Diagnosis and treatment of painful diabetic neuropathy
She was given a diagnosis of neuropathic pain, secondary to her small fibre neuropathy due to her diabetes. She was started on an increasing dose of Pregabalin, starting with 50 mg am, 100 mg pm. This was titrated up after a few weeks to 75 mg am and 150 mg pm.
Outcome following medication
She did extremely well with the medication, improving her symptoms of hypersensitivity greatly and fortunately, she had no problems with adverse effects with the Pregabalin, as compared to the multiple problems she had previously experienced with other medications including Gabapentin, weak opiates and Amitriptyline. She is due for review in the Pain Clinic in 3 months time.