Radiculopathy in diabetic polyneuropathy patients: difficulties in the diagnosis and therapy

Abstract

Neuropathic pain (NP) is not uncommon in clinical practice. NP can occur when various neural structures are damaged, such as peripheral nerves, spinal roots, spinal cord, and brain structures. Depending on the level of damage, NP is divided into central and peripheral. At the same time, peripheral NP is more common. When diagnosing NP, the results of a physical examination of the patient are the most valuable. In order to study the state of the peripheral neuromotor apparatus, patients undergo stimulation electromyography with an analysis of the conduction along motor fibers and sensory fibers caused by the skin sympathetic potential, and EMG using needle electrodes is often used to verify the level and stage of the pathological process. Difficulties in making a diagnosis arise when a patient has a combination of several types of neuropathic pain and comorbid pathology. For the treatment of NP, antidepressants, anticonvulsants, opioid analgesics, drugs for local anesthesia, botulinum toxin type A are used. Alpha-lipoic (thioctic) acid preparations are used in the treatment of diabetic polyneuropathy. The presence of several nosologies in a patient, each of which has individual manifestations of NP, determines the tactics of treating a particular patient, which is considered on the example of two clinical cases.

Keywords

• pain
• back pain
• neuropathic pain
• radiculopathy
• radicular compression syndrome
• diabetic polyneuropathy
• musculoskeletal pain
• pain syndrome
• diagnosis
• treatment