From the Guidelines
Peripheral neuropathy with denervation and muscle spasm should be treated with a combination of medications, including pregabalin, duloxetine, or gabapentin for neuropathic pain, and optimized glucose control to prevent or delay the development of neuropathy, as recommended by the most recent guidelines 1.
Symptoms and Treatment Options
The symptoms of peripheral neuropathy with denervation and muscle spasm include muscle weakness, atrophy, and involuntary contractions. Treatment options include:
- Medications such as pregabalin, duloxetine, or gabapentin to reduce neuropathic pain, as recommended by the 2021 standards of medical care in diabetes 1
- Optimized glucose control to prevent or delay the development of neuropathy, as recommended by the 2021 standards of medical care in diabetes 1
- Physical therapy to prevent contractures and maintain function
- Regular monitoring for medication side effects and adjustment of therapy based on symptom response
Medication Options
The following medications are recommended for the treatment of neuropathic pain in diabetes:
- Pregabalin (150-600 mg daily in divided doses)
- Duloxetine (60-120 mg daily)
- Gabapentin (starting at 300 mg daily, gradually increasing to 1800-3600 mg daily in divided doses) These medications have been shown to be effective in reducing neuropathic pain in patients with diabetes, as recommended by the 2021 standards of medical care in diabetes 1.
Importance of Glucose Control
Optimized glucose control is essential to prevent or delay the development of neuropathy in patients with diabetes, as recommended by the 2021 standards of medical care in diabetes 1. This can be achieved through a combination of lifestyle modifications, such as diet and exercise, and medication therapy. Regular monitoring of blood glucose levels and adjustment of therapy based on symptom response is essential for optimal outcomes.
From the Research
Symptoms of Peripheral Neuropathy with Denervation and Muscle Spasm
- Peripheral neuropathy can cause substantial morbidity and is associated with increased mortality 2
- Symptoms of peripheral neuropathy include pain, fasciculations, and muscle spasms 3
- Peripheral nerve hyperexcitability syndrome (PNHS) is characterized by muscle fasciculations and spasms, with nerve hyperexcitability and after-discharges observable in electrophysiological studies 3
- The most common symptoms of PNHS are fasciculations and muscle spasms, with electrodiagnostic findings of nerve hyperexcitability and after-discharges in the tibial nerve 3
Treatment Options for Peripheral Neuropathy with Denervation and Muscle Spasm
- First-line therapy for neuropathic pain in diabetic peripheral neuropathy (DPN) includes duloxetine and pregabalin 2, 4, 5
- Other treatment options for painful diabetic neuropathy (PDN) include gabapentin, amitriptyline, venlafaxine, and oxycodone as monotherapies or add-on therapies 4
- Tramadol appears to be effective as a monotherapy and add-on therapy in patients with peripheral neuropathy (PN) of various etiologies 4
- Dorsal column spinal cord stimulation (SCS) is a treatment option for PDN refractory to conventional medical therapy, with level I evidence supporting its use 5
- A meta-analysis comparing duloxetine, pregabalin, and gabapentin in the treatment of diabetic peripheral neuropathic pain found that all three drugs were superior to placebo, with some tolerability trade-offs 6