The Singapore Family Physician

Back to issue Vol 43 No. 1 - Cardiovascular Disorders 2

Pain Syndromes In Diabetes

Bernard Lee
The Singapore Family Physician Vol 43 No 1 - Cardiovascular Disorders 2
21 - 25
1 January 2017
There is an unmet need in achieving better pain management to improve quality of life in diabetics. Acute pain, chronic pain and painful diabetic neuropathy (PDN) are very frequently reported by diabetics along with anger and frustration related to pain. Diabetes is also associated with widespread symptoms and complications related to joint health and there is a strong link between the two conditions. Pain management is however generally neglected in diabetics as glucose and metabolic control always gains priority. It is very important to categorize the type of pain in diabetics and detailed history taking along with bedside examination are really crucial. Appropriate assessment is also necessary to determine if it requires immediate management or referral. Pain scales are very helpful to assess pain intensity and guide treatment selection and adjustment. Key goals of pain management include reduced pain and improved function with minimum acceptable side effects. Patients with severe or disabling pain requiring opioids may require referral to a specialist. Paracetamol should be the first-line analgesic agent for management of chronic pain due to its favorable side effect and safety profile. Non-steroidal anti-inflammatory drugs (NSAIDs) are however superior to paracetamol (combining both however increases efficacy) and COX-2 inhibitors (coxibs) offer safety advantages over non-selective NSAIDs. Non-opioid analgesics complement opioid analgesics for multimodal analgesia. Treatment of PDN necessitates use of specific therapeutic agents e.g. alpha-2-delta ligands (pregabalin, gabapentin), tricyclic antidepressants and serotonin-norepinephrine reuptake inhibitors.