Pharmacological approach for the management of patient with carpal tunnel syndrome associated to diabetic polyneuropathy. Case report

BACKGROUND AND OBJECTIVES: Peripheral neuropathy and carpal tunnel syndrome are debilitating diseases associated to diabetes mellitus in 12 to 21% of cases. There are no significant evidences of the clinical differentiation between such painful syndromes and their specific management. This study aimed at reporting the clinical presentation of a patient with peripheral polyneuropathy associated to carpal tunnel syndrome, focusing on therapeuthic approaches and discussing clinical differentiation between both diseases. CASE REPORT: Male patient, 68 years old, married, retired, who looked for medical assistance complaining of burning pain, especially in left upper limb. He also referred pain in lower limbs with night exacerbation, in addition to numbness in extremities and pain intensity of 6 in the visual analog scale. Presence of trigger- points in trapezius and levator scapulae muscles. Patient was submitted to decompression surgery due to carpal tunnel syndrome diagnosis two years ago, however without postoperative improvement. Patient refers pain in upper and lower limbs, with nocturnal exacerbation, numbness and pain in extremities. He has history of hypertension, diabetes mellitus type 2 and leprosy. At physical evaluation: painful boot and glove hypoesthesia and possible motor deficit in C6 and C7. Electromyography showed mixed peripheral polyneuropathy of lower limbs and median carpal syndrome to the left. There has been movement amplitude improvement in myotomes C6 and C7. Pain decreased to 3 in the visual analog scale after two weeks under gabapentin and duloxetine. CONCLUSION: It is difficult to clinically differentiate between neuropathy of different etiology and peripheral polyneuropathy. The proposed treatment has provided 50% improvement in the visual analog scale two weeks later. Lidocaine infusion at 5% has provided acute improvement of patient’s pain.