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Diabetes Chronic Complications - part 4

Thuốc giảm đau â € "này là sự vắng mặt của đau với các kích thích mà thông thường sẽ được đau đớn. Hypoalgesia â € "này là giảm đau đáp ứng với các kích thích thông thường gây đau đớn. Hyperalgesia â € "này là một phản ứng tăng lên một tác nhân kích thích bình thường không đau đớn. | 66 DIABETES AND FOOT DISEASE Hyperaesthesia - this is a heightened awareness of sensations or increased sensitivity to stimulation e.g. brushing or stroking of the skin. Hypoaesthesia - this is a decreased sensitivity to stimulation. Hyperpathia - this is a pain syndrome characterized by abnormally painful reactions to stimuli. Analgesia - this is the absence of pain to stimuli that would normally be painful. Hypoalgesia - this is diminished pain in response to normally painful stimuli. Hyperalgesia - this is an increased response to a stimuli that is not normally painful. Allodynia - this is the alteration of normal sensation into a painful or unpleasant sensation or pain due to a stimulus that does not usually provoke pain IASP . Paraesthesiae - this is a difficult sensation to describe. Pins and needles is an accurate if unscientific descriptor. It is an important discriminator between neuropathic pain and the rest pain of peripheral ischeamia. Risk factors for the development of painful diabetic neurpathy Increased age. Poor glycaemic control. Increased duration of diabetes. Smoking. Other microvascular complications - established complications such as nephropathy or retinopathy. Abnormal lipid metabolism - low levels of high-density lipoprotein HDL . Assessment of foot pain It is essential when assessing a patient with foot pain to take a detailed history. This should include detailed information about the type frequency and nature of CHARCOT FOOT 67 the pain precipitating and alleviating factors and other associated symptoms.37 A detailed past medical and medication history should be sought. There should be specific questioning about the presence of back pain and bowel bladder function. It is essential to rule out other causes of foot leg pain and the other causes of peripheral neuropathy. The pain may be severe and it is important to allow the patient to express their feelings and for the listener to be empathetic. An assessment of the impact of symptoms .