ISDN spray for pain and burning

[Guest guest]

Hello ers,

(Before you delete this because you think it is all about diabetes, read

through it for the news on ISDN Spray and how it works on neuropathic

pain. Perhaps one day it will make its way to some of us with burning

and pain in the CMT world ~ Gretchen)

Medscape Medical News

Diabetic Neuropathy, Gastropathy Respond to New Treatments

Laurie Barclay, MD

Oct. 3, 2002 — Complications from long-standing diabetes may respond to

new treatment strategies reported in the October issue of Diabetes Care.

Because diabetic neuropathy can be a painful condition that may be

associated with nitric oxide (NO), investigators tested a spray

containing isosorbide dinitrate (ISDN), a common NO donor used for heart

patients, and found that it reduced overall neuropathic pain and burning

with no effect on other symptoms. A letter in the same issue reported on

two patients with diabetic gastropathy in whom sildenafil improved

gastric emptying and clinical symptoms, suggesting a possible mechanism

and new therapy for diabetic gastropathy.

" Considerable evidence implicates impaired NO generation in the

pathogenesis of diabetic neuropathic pain, " write C. J. Yuen,

MRCP, from Addenbrooke's Hospital in Cambridge, U.K., and colleagues.

In this double-blind, two-period crossover design study, 22 diabetic

patients had a two-week run-in period before randomization to ISDN or

placebo sprays, then exchanged their treatment for an additional four

weeks after a two-week wash-out period. Of the 22 patients, 13 were men,

and 20 had type 2 diabetes. Mean age was 63.7 ± 1.8 years, duration of

diabetes was 9.1 ± 1.5 years, and duration of painful neuropathy was 2.6

± 0.4 years. The spray was administered to both feet before bedtime for

four weeks.

Compared with placebo, ISDN spray reduced overall neuropathic pain

(P=.02) and burning sensation (P=.006) without affecting other sensory

modalities such as hot or cold sensation, tingling, numbness,

hyperesthesia, or jabbing sensation. After treatment, 11 patients (50%)

reported benefit from the ISDN spray and wished to continue this

treatment, four (18%) preferred the placebo spray, and seven (32%) were

undecided.

" ISDN spray offers an alternative and effective pharmacological option

in relieving overall pain and burning sensation in the management of

painful diabetic neuropathy, " the authors write. " The potential of ISDN

spray in alleviating other specific sensory symptoms associated with

diabetic peripheral neuropathy merits further study. "

Because diabetic gastropathy may involve impairment of gastric nitrergic

neurons or of Cajal cells, Alessandro Bianco, MD, and colleagues from

Universita Cattolica in Rome, Italy, studied the effect of sildenafil in

two women with this disorder, and found that it improved gastric

emptying.

" It is conceivable that in diabetic gastropathy, sildenafil could

improve gastric emptying by reversing the loss of nitrergic

neurotransmitters, " they write. " It would be interesting to further

evaluate phosphodiesterase-type 5 inhibitors as a new therapeutic

approach to diabetic gastroparesis. "

Diabetes Care. 2002;25(10):1699-1703, 1888-1889

Reviewed by D. Vogin, MD

Laurie Barclay, MD, is a staff writer with WebMD.

Medscape Medical News is edited by Deborah Flapan, an associate editor

at Medscape. Please send press releases and comments to news@....

Medscape Medical News 2002. © 2002 Medscape