UNIVERSITY OF CENTRAL LANCASHIRE - Theses Submission Form
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Amir Aslam
4 Prominence Park SW
Calgary, Alberta
CANADA
T3H 4K8
AmirAslam@hotmail.com
+15873542647
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1. Thesis submission form
2. THESIS Prevalence and treatment of painful diabetic
neuropathy.pdf
3. 1.Aslam V2 Diabetes and primary care.pdf
4. 2.Pathogenesis of PDN (Pain Research journal) - Copy.pdf
5. 3.Clin Diabetes-2014-Aslam-26-7.pdf
6. 4.AslamNov2013 (2) (1).pdf
7. 5.DOLSAslam.pdf
Prevalence and treatment of painful diabetic neuropathy
Abstract
Abstract
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description of your work,
or copy an abstract you
have included in the
Thesis
The prevalence of diabetes is rising globally and, as a result, its associated
complications are also rising. Painful diabetic neuropathy (PDN) is a wellknown complication of diabetes and the most common cause of all
neuropathic pain. About one-third of all diabetes patients suffer from PDN.
The reported prevalence of PDN varies from 11% in Rochester, Minnesota,
USA to 53.7% in the Middle East. One UK study, published in 2011,
reported that the prevalence of PDN was 21.5% in type 2 diabetes patients
and 13.4% in type 1 diabetes patients, resulting in an overall prevalence of
21%. Numerous studies have found cardiovascular risk factors—including
increased age, longer duration of diabetes, higher weight, smoking, poor
glycaemic control, renal impairment and high cholesterol—to be
associated with PDN. This disorder has a huge effect on people’s daily lives
both physically and mentally. Despite huge advances in medicine, the
treatment of PDN is both challenging for physicians and distressing for
patients. In this thesis, three studies were carried out on the following
topics: prevalence and characteristics of painful diabetic neuropathy, PDN
patients’ quality of life, and treatment employing lignocaine.
This first study assessed the prevalence of painful diabetic neuropathy
(PDN) and its relationship with various cardiovascular characteristics in
diabetes subjects. This was done through an observational study of
diabetes subjects in Northwest England, UK (n =204). The self-completed
Leeds Assessment of Neuropathic Symptoms and Signs questionnaire was
sent by post to the subjects and used to diagnose PDN. Consent for
participation and access to blood results was given by the study
participants. Ethical approval for the study was also granted by National
Research Ethics Committee UK. The results of the study showed that the
crude prevalence of PDN among subjects was 30.3%. The prevalence of
type 2 diabetes subjects was higher (33.1 %) than that of type 1 diabetes
subjects (14.1%). There was a significant association of obesity, smoking
and height in males with PDN compared to the non-PDN group (P <0.05).
The results also showed a significant trend of increasing PDN prevalence
with duration of diabetes, increasing HbA1c and increasing BMI (P<0.05).
There was a trend of increasing prevalence with age as well (P>0.05);
however, due to the small sample size, the data was not statistically
significant. There was no relationship of PDN with systolic or diastolic
blood pressure, nephropathy, alcohol intake or blood cholesterol (P>0.05).
These results highlight the importance of better control of modifiable
factors, including smoking, glycaemic control (HbA1c) and obesity.
The second study assessed the impact of painful diabetic neuropathy on
quality of life (QoL), mood and anxiety by comparing patients suffering
from painful diabetic neuropathy (PDN group) with diabetes patients not
known to have PDN (control group, C). The study used short form (SF) 36
and Hospital Anxiety and Depression Scale (HADS Scale) questionnaires.
For the PDN group, 25 adult subjects (mean age 56, standard deviation
(SD) +/- 11 years, male 15, female 10) were randomly selected from
patients attending the painful diabetes neuropathy clinic at Chorley
Hospital. For the control group, 25 adult diabetic subjects (mean age 56,
SD +/- 14 years, male 14, female 9) were randomly selected from patients
undergoing General Practitioner Surgery. Both groups completed the
HADS and SF36 questionnaires. Subjects in the PDN group had significantly
lower SF36 summary scores in both the physical health (P ˂0.0001) and
mental health domains (P= 0.026) compared with the C group. HADS data
showed that 56% subjects in the PDN group could be diagnosed anxiety
compared to only 20% in the C group (P=0.018); and 60% of the PDN group
received the diagnosis of depression compare to 44% in the C group
(P=0.396). The results also show that PDN was significantly associated with
impaired QoL, both physically (p<0.0001) and mentally (p<0.026). Anxiety
was significantly associated with the PDN group compared to control
(p<0.018), and depression was 16% more prevalent in PDN group than in
the control group.
The final study assessed the efficacy of lignocaine infusion as a treatment
for PDN in challenging cases where conventional treatment had not
helped. A total 11 patients participated; 7 patients were referred from the
pain clinic (non-PDN group), and 4 were referred from the foot clinic (PDN
group). All were given lignocaine infusion as a treatment for chronic pain.
Participants from both groups were on multiple pain medications with
minimal results. All participants gave consent for participation and filled
out a McGill short form (SF) questionnaire before and after lignocaine
infusion. The results showed a 33% reduction in the visual analogue pain
score after lignocaine infusion in PDN group compared to an 11%
reduction in the non-PDN group. The data were statistically significant
(P<0.05). Similarly, there was significant (p<0.05) reduction of affective
pain score: 41% after lignocaine infusion in PDN group, compared to 21%
in non-PDN group. In contrast, no significant difference was seen between
groups for the sensory pain score reduction after lignocaine infusion: 23%
in PDN group compared to 17% in non-PDN group (P>0.05). None of the 11
patients reported adverse effects from the treatment and their
observations were within normal limits throughout the lignocaine infusion.
Overall, the study showed that lignocaine infusion is effective and safe in
reducing the chronic intractable pain when conventional treatments are
intolerable or unhelpful. The treatment is also more effective for painful
diabetic neuropathy than for other forms of chronic pain.
Qualification level
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Masters
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MSc
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Amir Aslam
School
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Pharmacy and Biomedical Sciences
Number of pages
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pages to thesis
176 + Publications papers PDF files attached in the end.
(5+8+2+1+3=19)
Total: 176 + 19= 195
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Diabetes
Painful diabetic neuropathy
Impact of painful diabetic neuropathy on quality of life
Lignocaine infusion as a treatment of painful diabetic neuropathy
in challenging cases.
Medicine
Medicine
N/A
Aslam A, Singh J, Rajbhandari S (2014). The impact of painful diabetic
neuropathy on quality of life. Diabetes & Primary Care; 16(4):212-219
Amir Aslam, Jaipaul Singh, and Satyan Rajbhandari, “Pathogenesis of
Painful Diabetic Neuropathy,” Pain Research and Treatment, vol. 2014,
Article ID 412041, 7 pages, 2014. doi:10.1155/2014/412041
A Aslam, J Byrne, SM Rajbhandari. Abdominal Pain and Weight Loss in
New-Onset Type 1 Diabetes. Clinical Diabetes: 2014, 32(1); 26-27
Prevalence of painful diabetic neuropathy chapter currently under review
in Canadian journal of diabetes
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