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Wound and Pain Management for Diabetes

Wound and Pain Management for Diabetes

  • Wound and Pain Management for Diabetes
  • Botulinum Toxin-A Shows Analgesic Effect in Neuropathic Pain. • Painful diabetic neuropathy is a debilitating complication of diabetes that greatly affects patients’ quality of life. • Recent studies show botulinum toxin-A induces a promising analgesic effect for neuropathic pain. • These researchers conducted a meta-analysis of 2 studies using botulinum toxin-A in the treatment of neuropathic pain.
  • Clinically Significant Improvement in Painful Diabetic Neuropathy. • The meta-analysis showed improvement on the visual analogue scale following treatment with botulinum toxin-A. • The improvement corresponds to a clinically significant improvement of “minimum change in pain.” • Infection at the injection site was not statistically significant. • The results suggest there is a correlation between botulinum toxin-A and improvement of pain scores in painful diabetic neuropathy.
  • Inhaled Cannabis Reduces Diabetic Neuropathy. • Inhaled cannabis appears to reduce diabetic neuropathy in a dose-dependent manner. • Researchers conducted a randomized, double-blind, placebo-controlled, crossover study of 16 patients with painful diabetic peripheral neuropathy to assess the short-term efficacy and tolerability of inhaled cannabis. • Each participant participated in 4 outpatient treatment sessions, separated by two weeks, in which they were exposed to placebo or 3 different doses of aerosolized tetrahydrocannabinol (THC), 1% THC for a low dose, 4% THC for a medium dose, or 7% THC for a high dose of cannabis.
  • Dose-dependent Reduction in Pain Intensity. • Results showed there was a dose-dependent reduction in pain intensity from inhaled cannabis. • The dose-dependent analgesic effect was evident for both spontaneous and evoked pain, but it was more consistent for spontaneous pain. • All subjects experienced either euphoria or somnolence, but the impact on cognition was modest. • These findings suggest that cannabis might have an analgesic benefit in neuropathic pain syndromes, including treatment-refractory diabetic peripheral neuropathy.
  • Neutrophils Impair Wound Healing in Diabetes. • Neutrophils are the main leukocytes involved in the early phase of wound healing, which is impaired in patients with diabetes. • Neutrophils form extracellular traps (NETs) that can also induce tissue damage. • These researchers isolated neutrophils from type 1 and type 2 diabetic humans and mice, and showed they were primed to produce NETs, a process termed NETosis.
  • Elevated Marker of Neutrophils Found in Diabetes Patients. • An enzyme important in the formation of NETs was elevated in the neutrophils from individuals with diabetes. • In diabetic mice, higher levels of a NET marker were found in wounds than in mice with normal glycemic levels, and healing was delayed. • The researchers conclude that NETs impair wound healing, particularly in diabetes, in which neutrophils are more susceptible to NETosis.
  • Take-home Messages. • Botulinum toxin-A may be an effective treatment for painful diabetic neuropathy. • Inhaled cannabis may lead to a dose-dependent reduction in diabetic peripheral neuropathy pain in patients with treatment-refractory pain. • Inhibiting neutrophils may improve wound healing and reduce chronic inflammation in diabetes.

Treatments with botulinum toxin-A may help reduce painful diabetic neuropathy, according to a new meta-analysis. Inhaled cannabis may have an analgesic effect in neuropathic pain syndromes, including treatment-refractory diabetic peripheral neuropathy. Diabetes patients appear to have elevated levels of neutrophils, which impair wound healing.

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