Intraosseous blocks in the treatment of diabetic symmetrical distal polyneuropathy
Aim. To evaluate the efficiency of intraosseous blocks (IOB) in the combination treatment of patients with painful diabetic symmetrical distal polyneuropathy (DSDP) of the lower limbs. Subjects and methods. Seventy-eight patients with painful DSDP were examined. Its diagnosis was verified by neurological examination, assessments of the data of the neuropathic pain diagnostic (DN4) questionnaire and electroneuromyography (ENMG). The pain syndrome was evaluated with a combined visual analogue scale (VAS). The degree of DSDP was estimated using the total symptoms score (TSS) and the neuropathy impairment scale-lower limbs (NIS-LL) scale. The Spielberger questionnaire was used to evaluate reactive and trait anxiety and the Beck inventory was employed to estimate the level of depression. A study group comprised 40 patients receiving IOB as part of the standard treatment. A control group consisted of 38 patients taking oral amitriptyline as a component of the standard treatment. Therapeutic effectiveness was evaluated, by changing the neurological status, trends in VAS, TSS, and NIS-LL scores, and data of psychological questionnaires and ENMG before and after the course of therapy and 1, 3, and 6 months after treatment. Results. IOB was found to be highly effective in pain syndrome, affective disorders, and other manifestations of DSDP; moreover, the therapeutic effect persisted within 6 months after treatment.