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.