SA JOURNAL OF DIABETES & VASCULAR DISEASE
EDITORIAL
VOLUME 7 NUMBER 4 • NOVEMBER 2010
137
this country. Lidocaine gel (5%) is a cheaper and effective alternative
to patches,
20
and a weaker version, Remicaine
®
(lignocaine gel 2%)
is readily available in South Africa.
Capsicum-containing creams available in South Africa, e.g.
Sloan’s Heat Rub
®
can be tried as alternative to topical capsaicin
and can be purchased privately. Methyl salicylate ointment
(‘Wintergreen’) is available from public health institutions and is
frequently prescribed for various painful conditions in the limbs.
Whether its effect is physiological or due to a placebo effect is
debatable, but if it relieves symptoms via either mechanism and
avoids the patient seeking more potent medication with more
adverse effects, then its use can be considered justified.
29
While alpha-lipoic acid was referred to by Tesfaye and Selvarajah
2
as a treatment for neuropathic pain, there is evidence that as a
disease-modifying drug it could prove to be more cost effective
than using other drugs for symptomatic treatment of PDN.
30
However, this remains to be proven in the South African setting
where again, it is as yet only available in the private sector.
As an ‘end-of-the-line’ treatment, when all else fails to relieve
pain, the authors suggest referral to a chronic pain-management
service. Again, the problem in South Africa is of there being only a
handful of public health pain-management units to which to refer
patients. Private-sector patients may also experience difficulties
accessing these units as medical aid schemes are frequently
unwilling to pay for the costs of pain-management programmes
(PMPs) in these units. This is unfortunate as patients with chronic
pain from any cause benefit from a bio-psycho-social approach to
their condition.
The emphasis in PMPs is on helping patients to live a functional
life despite pain and to reduce medication-seeking behaviour. In
this way, PMPs can ultimately reduce the medical costs of a patient
and their use should be considered earlier rather than later in the
management plan of patients with PDN.
Conclusion
Many of the drugs cited in the article by Tesfaye and Selvarajah
2
are available in South Africa for the treatment of PDN and should
be prescribed in a step-wise fashion according to symptoms and
adverse effects. If a public health practitioner is not permitted to
prescribe a certain drug due to the prescriber restriction code of
the drug, then he/she should send the patient to a higher-level
institution where it may be prescribed.
Medical practitioners should regularly ask diabetic patients if they
have symptoms of PDN and this, in conjunction with public health
education regarding the prevention of diabetes due to obesity, may
help reduce the number of diabetic patients in South Africa who
are experiencing distressing pain from diabetic neuropathy.
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