Review of the Adverse Effects of Prolonged Pain Relief Use in Diabetic Patients

Abstract

Background:

Diabetic neuropathic pain is a prevalent and debilitating complication of diabetes mellitus, often necessitating prolonged use of pain relief medications. While these medications are effective in managing pain, their extended use may lead to adverse effects, complicating diabetes management. This systematic review aims to evaluate the side effects associated with prolonged use of pain relief medications in diabetic patients.

Methods:

A comprehensive literature search was conducted across multiple databases, including PubMed, Scopus, and Cochrane Library. Inclusion criteria encompassed randomized controlled trials, cohort studies, and systematic reviews that assessed the side effects of pain relief medications in diabetic patients. Data extraction focused on study design, sample size, medication type, duration of use, and reported adverse effects. The quality of included studies was appraised using the Cochrane Risk of Bias Tool.

Results:

Out of 854 initially identified studies, 12 met the inclusion criteria: six clinical trials and six cohort studies. These studies varied in sample sizes, ranging from 150 to 1,200 participants, and were conducted across diverse geographic regions, including North America, Europe, Asia, and the Middle East. The primary focus was on renal side effects, with findings indicating significant risks associated with prolonged use of certain medications. For instance, gabapentinoids were linked to a 1.4-fold increased risk of chronic kidney disease progression. Secondary outcomes included gastrointestinal and cardiovascular side effects, with opioids associated with a 25% prevalence of gastrointestinal symptoms and tricyclic antidepressants linked to a 9% incidence of arrhythmias. Subgroup analyses identified older age and longer diabetes duration as significant risk factors for adverse outcomes.

Conclusions:

Prolonged use of pain relief medications in diabetic patients is associated with notable adverse effects, particularly renal, gastrointestinal, and cardiovascular complications. Healthcare providers should exercise caution in prescribing these medications, considering individual patient factors and implementing regular monitoring to mitigate potential risks. Further research is warranted to develop safer treatment protocols and identify at-risk populations for tailored interventions.