Dolor por polineuropatía simétrica distal en la diabetes mellitus
DOI:
https://doi.org/10.5294/aqui.2021.21.3.7Palabras clave:
Neuropatías diabéticas, dolor crónico, diabetes mellitus, complicaciones, fisioterapia, enfermeríaResumen
Objetivo: evaluar el dolor neuropático (DN), su intensidad y sus complicaciones en personas con diabetes mellitus tipo 2 (DM2) en una ciudad del este de São Paulo.
Método: estudio transversal realizado con 96 individuos con DM2 atendidos en unidades básicas de salud en São João da Boa Vista-SP. Se utilizaron los siguientes instrumentos para rastrear el DN: el instrumento para la detección de la neuropatía de Michigan, la evaluación de signos y síntomas neuropáticos de Leeds, el cuestionario Douleur Neuropathique 4 y el inventario breve del dolor. Los datos se analizaron mediante estadística descriptiva e inferencial, con un nivel de significancia del 5 %.
Resultados: de las 96 personas con DM2 durante más de cinco años, el 22,9 % tenía dolor. El DN se relacionó con niveles altos de glucosa en sangre en ayunas (media = 214 ± 65,58 mg/dl; p = 0,0002), la hemoglobina glucosilada (media = 8,8 ± 0,11 %; p < 0,001), la ausencia de una dieta (p = 0,0066), la obesidad (p = 0,023) y la hipertensión arterial (p < 0,001).
Conclusión: los altos valores en las tasas de hemoglobina glucosilada aumentaron tres veces la probabilidad de DN. La detección y el tratamiento de la neuropatía diabética dolorosa es un desafío, pero la adopción de un protocolo de detección contribuye a la prevención secundaria de esta manifestación.
Descargas
Citas
American Diabetes Association. Standards of Medical Care in Diabetes 2019. Diabetes Care. 2019;42(Suppl. 1):S4–S6. DOI: https://doi.org/10.2337/dc19-Srev01
Iqbal Z, Azmi S, Yadav R, Lim J, Malik RA, Alam U., et al. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther. 2018;40(6):828-849. DOI: https://doi.org/10.1016/j.clinthera.2018.04.001
Brazilian Diabetes Society. Diabetic Neuropathies: Position of the American Diabetes Association. 2019. DOI: https://doi.org/10.2337/dc16-2042
Sloan G, Shillo P, Selvarajah D, Wu J, Wilkinson ID, Tracey I, et al. A new look at painful diabetic neuropathy. Diabetes Res Clin Pract. 2018;144:177-191. DOI: https://doi.org/10.1016/j.diabres.2018.08.020
Shillo P, Sloan G, Greig M, Hunt L, Selvarajah D, Elliott J, et al. Painful and painless diabetic neuropathies: what is the difference? Curr Diabetes Rep. 2019;19:32. DOI: https://doi.org/10.1007/s11892-019-1150-5
Oliveira Volpe CM, Villar-Delfino PH, Ferreira dos Anjos PM, Nogueira-Machado JA. Cellular death, reactive oxygen species (ROS) and diabetic complications. Cell Death Dis. 2018:9,119. DOI: https://doi.org/10.1038/s41419-017-0135-z
Raputova J, Srotova I, Vlckova E, Sommer C, Uceyler N, Birklein F, et al. Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study. Pain. 2017;158:2340–53. DOI: https://doi.org/10.1097/j.pain.0000000000001034
Brazilian Diabetes Society. Guidelines for the Brazilian Society of Diabetes: 2013-2014. São Paulo: Pharmaceutical Ac, 2014. Available from: https://nutritotal.com.br/pro/wp-content/uploads/sites/3/2014/04/342-diretrizessbd.pdf
Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017;16(3). DOI: https://doi.org/10.1038/nrdp.2017.2
Raputova J, Vlckova E, Sommer C, Üçeyler N, Birklein F, Rittner HL, et al. Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study. Pain. 2017;158(12):2340-2353. DOI: https://doi.org/10.1097/j.pain.0000000000001034
Sifuentes-Franco S, Padilla-Tejeda DE, Carrillo-Ibarra S, Miranda-Díaz AG. Oxidative Stress, Apoptosis, and Mitochondrial Function in Diabetic Nephropathy. Int J Endocrinol. 2018;1. DOI: https://doi.org/10.1155/2018/1875870
Zhou W, Yuan Yao Y, Li J, Wu D, Zhao M, Yan Z, et al. TIGAR Attenuates High Glucose-Induced Neuronal Apoptosis via an Autophagy Pathway. Front Mol Neurosci. 2019;12:193. DOI: https://doi.org/10.3389/fnmol.2019.00193
Oliveira FB, Botelho KKP, Bezerra AR, Azevedo DIO, Couto CCS, Martins EF. Cross-cultural adaptation to Brazilian Portuguese of the Michigan neuropathy screening Instrument: MNSI - Brazil. Clinical Sales, Criteria and Tools. Arq Neuropsiquiatr. 2016;74(8):653-6612. DOI: https://doi.org/10.1590/0004-282X20160094
Barbosa M, Saavedra A, Severo M, Maier C, Carvalho D. Validation and reliability of the Portuguese version of the Michigan Neuropathy Screening Instrument. Pain Pract. 2016;17(4):514-521. DOI: https://doi.org/10.1111/papr.12479
Schestatsky C, Félix-Torres V, Chaves MLF, Câmara-Ehlers B, Mucenic T, Caumo W, et al. Brazilian Portuguese validation of the Leeds assessment of neuropathic symptoms and signs for patients with chronic pain. Pain Medicine, 2011;12:1544–1550. DOI: https://doi.org/10.1111/j.1526-4637.2011.01221.x
Santos JG, Brito JO, De Andrade DC, Kaziyama VM, Ferreira KA, Souza I, et al. Translation to Portuguese and validation of the Douleur Neuropathique 4 questionnaire. J Pain. 2011;11(5):484-90. DOI: https://doi.org/10.1016/j.jpain.2009.09.014
Ferreira KA, Teixeira MJ, Mendonza TR, Cleeland CS. Validation of brief pain inventory to Brazilian patients with pain. Support Care Cancer. 2011;19(4):505-11. DOI: https://doi.org/10.1007/s00520-010-0844-7
Sarah A, Endrizzi MD, James P, Rathmell MD, Robert W, Hurley MD. Painful Peripheral Neuropathies. Essentials of Pain Medicine. 4ed. 2018: 273-282. DOI: https://doi.org/10.1016/B978-0-323-40196-8.00032-2
MNSI - Michigan Neuropathy Screening Instrument. Michigan Diabetes Research and Training Center. 2010. Available from: http://www.med.umich.edu/borc/profs/documents/svi/MNSI_patient.pdf
Sartor CD, Oliveira MD, Campos V, Ferreira JSSP, Sacco ICN. Cross-cultural adaptation and measurement properties of the Brazilian Version of the Michigan Neuropathy Screening Instrument. Braz J Phys Ther. 2018;22(3):222-230. DOI: https://doi.org/10.1016/j.bjpt.2017.10.004
Crucru G, Truini A. Neuropathic Pain: The Scope of the Problem. Pain and Therapy. 2017;6:1–3. DOI: https://doi.org/10.1007/s40122-017-0086-1
Carvalho AB, Garcia JS, Silva TKM, Riberio JVF. Translation and transcultural adaptation of pain quality assessment scale (PQAS) to Brazilian version. Braz J Anestesiol. 2016;66(1):94-104. DOI: https://doi.org/10.1016/j.bjane.2013.10.018
Agoons BB, Tchapmi D, Boli AO, Katte JC. Clinical utility of the DN4 questionnaire in the assessment of neuropathic pain in patients with type 2 diabetes: experience from a newly created diabetes clinic in Cameroon. PAMJ - Clinical Medicine. 2020:165(3). DOI: https://doi.org/10.11604/pamj-cm.2020.3.165.23789
Ministry of Health, Health Care Secretariat, Ordinance No. 1,083, of October 2, 2012. Available from: http://bvsms.saude.gov.br/bvs/saudelegis/sas/2012/prt1083_02_10_2012.html
Moreno RA, Moreno DH. Escalas de depressão de Montgomery & Asberg (MADRS) e de Hamilton (HAM-D). Rev Psiquiatr Clin. 1998;25:262-72. https://pesquisa.bvsalud.org/portal/resource/pt/lil-228053
Katigari MR, Ayatollahi H, Malek M, Haghighi MK. Fuzzy expert system for diagnosing diabetic neuropathy. World J Diabetes. 2017;8(2):80-88. DOI: https://doi.org/10.4239/wjd.v8.i2.80
Rouquayrol MZ, Gurge M. Epidemiologia e Saúde. 8 ed. Rio de Janeiro. Meedbook, 2017.
Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(41). DOI: https://doi.org/10.1038/s41572-019-0092-1
Assunção A, Campos D, Marques R, Cunha I, Santos P, Martins A, et al. The impact of demographic and clinical characteristics on diabetic painful neuropathy. Rom J Intern Med. 2020;58(1):13–19. DOI: https://doi.org/10.2478/rjim-2019-0019
Hicks CW, Selvin E. Epidemiology of Peripheral Neuropathy and Lower Extremity Disease in Diabetes. Curr Diab Rep. 2019 Aug 27;19(10):86. DOI: https://doi.org/10.1007/s11892-019-1212-8
Cortez J, Reis C, Cardoso Y, Onofre A, Piovezan AP. Prevalência de dor neuropática e fatores associados em portadores de diabetes mellitus tipo 2 atendidos em ambulatório médico* SC. Rev Dor. 2014;15(4). DOI: https://doi.org/10.5935/1806-0013.20140055
Gylfadottir SS, Christensen DH, Nicolaisen SK, Andersen H, Callaghan BC, Itani M, Khan KS, et al. Diabetic polyneuropathy and pain, prevalence, and patient characteristics: a cross-sectional questionnaire study of 5,514 patients with recently diagnosed type 2 diabetes. Pain. 2019. DOI: https://doi.org/10.1097/j.pain.0000000000001744
Baron R, Maier C, Attal N, Binder A, Bouhassira D, Cruccu G, et al. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain. 2017;158(2):261-272. DOI: https://doi.org/10.1097/j.pain.0000000000000753
Celik S, Yenidunya G, Temel E, Purisa S, Uzum AK, Gul N, et al. Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus. Kidney Care Diabetes. 2016;10(4): 259-64. DOI: https://doi.org/10.1016/j.pcd.2015.11.005
Jensen TS, Finnerup NB. Allodynia and hyperalgesia in neuropathic pain: clinical manifestations and mechanisms. Lancet Neurol. 2014;13(9):924-35. DOI: https://doi.org/10.1016/S1474-4422(14)70102-4
Garoushi S, Jonhson MI, Tashani OA. A cross-sectional study to estimate the point prevalence of painful diabetic neuropathy in Eastern Libya. BMC Public Health. 2019;19:78. DOI: https://doi.org/10.1186/s12889-018-6374-9
American Diabetes Association. Standards of Medical Care in Diabetes — 2017. Diabetes Care. 2017;40(1):S1–S135. https://care.diabetesjournals.org/content/diacare/suppl/2016/12/15/40.Supplement_1.DC1/DC_40_S1_final.pdf
Rolim LC, Koga da Silva EM, De Sá JR, Dib SA. A Systematic Review of Treatment of Painful Diabetic Neuropathy by Pain Phenotype versus Treatment Based on Medical Comorbidities. Front Neurol. 2017. DOI: https://doi.org/10.3389/fneur.2017.00285
Pop-Busui R, Boulton AJM, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40(1):136-54. DOI: https://doi.org/10.2337/dc16-2042
Pai YW, Lin CH, Lee IT, Chang MH. Prevalence and biochemical risk factors of diabetic peripheral neuropathy with or without neuropathic pain in Taiwanese adults with type 2 diabetes mellitus. Diabetes Metab Syndr. 2018;12(2):111-116. DOI: https://doi.org/10.1016/j.dsx.2017.09.013
Ponirakis G, Elhadd T, Chinnaiyan S, Dabbous Z, Siddiqui M, Al-Muhannadi H, et al. Prevalence and management of diabetic neuropathy in secondary care in Qatar. Diabetes Metab Res Rev. 2020;8. DOI: https://doi.org/10.1002/dmrr.3286
Pedrosa HC, Vilar L, Boulton AJM et al. Neuropatias e pés Diabéticos. ACF. 2013.
Udall M, Kudel I, Cappelleri JC, Sadosky A, King-Concialdi K, Parsons B, et al. Epidemiology of physician-diagnosed neuropathic pain in Brazil. J Pain Res. 2019;7(12):243-253. DOI: https://doi.org/10.2147/JPR.S160504
Descargas
Publicado
Cómo citar
Número
Sección
Licencia
Derechos de autor 2021 Aquichan
Esta obra está bajo una licencia internacional Creative Commons Atribución-NoComercial-SinDerivadas 4.0.
Esta revista y sus artículos se publican bajo la licencia CreativeCommons CC BY 4.0 DEED Atribución 4.0 Internacional, usted es libre de: Compartir — copiar y redistribuir el material en cualquier medio o formato para cualquier propósito, incluso comercialmente. Adaptar — remezclar, transformar y construir a partir del material para cualquier propósito, incluso comercialmente. La licencia no puede revocar estas libertades en tanto usted siga los términos de la licencia.
