If doubts about the diagnosis remain, then taking duphalac fluid for immunohistological examination and, if necessary, a nerve biopsy can clarify the diagnosis. In most cases, the initial symptoms are intermittent pain or paresthesia. Even in the case of severe pain, they usually disappear spontaneously after a few months in most patients, but not in all. Many patients believe that pain is a manifestation of cancer, and convincing them otherwise often alleviates suffering in itself.

However, in the absence of pain or paresthesia, diabetic neuropathy can remain undiagnosed for a long time unless at least a minimal (see above) set of diagnostic instrumental tests is performed by the physician. The persistent and severe pain of neuropathy is treated with a variety of drugs, including conventional analgesics and other agents used for pain relief and other conditions. Drugs are recommended to be avoided. Tricyclic antidepressants (TCAs) have been used in clinical practice for over 40 years to treat a variety of conditions, including depression and neuropathic pain. TCAs were duphalac drugs in placebo-controlled studies that proved effective in the treatment of neuropathic pain in diabetic polyneuropathy. In this regard, they are among the drugs of first choice in the elimination of neuropathic pain.

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TCAs are distributed predominantly in the brain, heart, liver, and lungs. The peak concentration is reached within 24 hours, but the maximum effect occurs only after 1-2 weeks. TCAs bind to proteins and therefore compete for binding with other drugs that have these qualities (warfarin). TCA drugs have a different half-life - from 6 to 100 hours. Metabolism is carried out mainly in the liver, and excretion - with urine and feces. The effect of treating diabetic neuropathy is observed with any TCA, and only side effects are an obstacle. TCAs are divided into two categories - secondary amines (amitriptyline, imipramine) and tertiary amines (nortriptyline, desipramine).

While the mechanisms of action of these groups of lactulose bottles drugs are the same, their side effects manifest themselves in different ways. Secondary amines have a markedly lower incidence of side effects compared to tertiary amines and are therefore preferred in the treatment of diabetic neuropathy.

The effectiveness of TCAs depends on the achieved plasma concentration, and at the same time, the elimination of pain occurs earlier (after a few days) than their antidepressant effect manifests itself. However, a third of patients cannot take them due to side effects. To reduce side effects, it is recommended to start taking them with a minimum dose at bedtime (for example,ep, 10-25 mg amitriptyline) with a further gradual increase. Patients with suicidal thoughts should be carefully monitored while taking these drugs, as they are highly toxic and can cause death if taken inappropriately. In elderly patients, these drugs can cause confusion, delirium, and acute dementia.

Not recommended for use during pregnancy and lactation. It is recommended to titrate the dose, which may take several weeks or months until the goal of treatment is achieved. TCAs can be taken with other drugs for the treatment of diabetic neuropathy - pregabalin and gabapentin. With neuropathic pain, it is also possible to use lactulose bottles anesthetics, lidocaine or capsaicin ointment. The effect of topical application of lidocaine occurs after 5-15 minutes. In the blood, at the same time, its concentration is 1/10 of that which affects the activity of the heart, and therefore, with regard to cardiac activity, local use of lidocaine is safe. Metabolism is carried out in the liver, and excreted through the kidneys.