Painful Diabetic Neuropathy in Senegal, the Gambia or in other SSA countries
Project to help diabetic pain patient in the Gambia.
Prevalence of Diabetes since 1980 is rising
In The Gambia, the poorest country in Africa, where a working person earns an average of 1 euro a day, there are many people with diabetic pains (Painful Diabetic Neuropathy).  They mostly seems to use paracetamol for these pains, which we know, as doctors, that this does not work easing the pains. You have to treat diabetic pains differently. This also holds true for Senegal and other Subsaharean African countries (SSA).
Since 1980 the prevalence of Diabetes has doubled, according to the WHO (see graph)
We have done a lot of development work in recent years and have now developed an analgesic cream, which gives pain relief after 30 minutes after applying to the painful areas. The active substance phenytoin, is very old, and was first discovered in the clinic in 1938 due to its special nerve-balancing properties.    
In 2017 we made a small start exploring how to set up a possible project to treat patients suffering from severe nerve pain in one of the SSA countries. We started exploring this with the initial support of Gambian medical colleagues. We will explore the opportunities for Senegal and other SSA countries step by step. Gambia is the first pilot.
Gambia and diabetic pains
The Gambia stretches 450 km along the Gambia River, its borders are completely surrounded by Senegal except for 60 km of Atlantic Ocean beachfront. It is the smallest country of the African continent. Its population is 2 million, and the rate of growth is 2.8% per year over the last decade.
Diabetes increases in The Gambia, W.H.O. estimates diabetes by 2030 over 18 million people will have the condition in Africa.
Diabetes is a deadly disease that affects 371 million people worldwide, and 187 million of them do not even know they have diabetes. The Gambia is not immune to this disease. According to recent World Health Organization (WHO) data, The Gambian population has a higher percentage overall of raised blood glucose level compared to other Sub-Saharan Africa countries. Clearly, something needs to be done about diabetes in The Gambia.
Project Phenytoin Cream in Painful Diabetic Neuropathy
In January, the first contacts were made with a colleague from the Medical Research Council there, to map the first steps and to get an impression of whether the treatment of painful diabetic neuropathy in the patients of Gambia would be possible.
Gambia is one of the poorest African countries, with many untreated patients suffering from painful diabetic neuropathy.
In the Gambia there are many patients with untreated painful diabetic neuropathy
In the period January-April, the first preparations were made to have conversations with various doctors working in the Gambia health care. Furthermore, the landscape of the treatment of painful diabetic neuropathy has been mapped, as is currently the case in Sub-Saharan African (SSA) countries.
In April there were talks at various locations of medical facilities in Gambia, and the first samples of phenytoin cream and placebo cream were issued to one of the coordinating doctors.
A start has also been made with the first article, which analyzes the context of painful diabetic neuropathy in the Sub-Saharan African (SSA) countries and determines the place of treatment with phenytoin cream.
There has also been contact with a charity and publicity activist in the Gambia, the DJ G Faal, who acts on behalf of the Diabetes Gambia association.
In addition, discussions were held in which options were also discussed to place parts of the phenytoin project in Nigeria, where contact is possible with a gasteroenterologist.
Repositioning of phenytoin in poor SSA countries
Repositioning of phenytoin as an analgesic drug in non-main countries is meanwhile identified in the world, and at the 3rd Eastern-European Pain Congress: 7−9 June 2018 in Kyiv, Ukraine we will present a number of latest findings related to the project of repurposing phenytoin as a cream for the treatment of peripheral neuropathic pain. Topics presented will be: ‘new developments in topical treatment of peripheral neuropathic pain from the perspective of repositioned drugs’
‘Enrichment designs in topical analgesic treatment, the role of a single blind response test in research a daily practice’, and: ‘the role of topical phenytoin formulations in the treatment of peripheral neuropathic pain.’
Gambia is one of the poor Sub Saharan African Countries
Gambia Health system
The healthcare system in the Gambia is basically a 3 level-system:
1. the first level is focused on small villages with populations of over 400 individuals.
2. On a secondary level health care is provided by large and small health centres in somewhat bigger agglomeraties.
3. Care is delivered by 4 big referral hospitals and organisations: the Medical Research Council (MRC), several private clinics and NGO operated clinics. The MRC would be the body to further evaluate and support the project if it would be viable.
In addition to the 4 referral hospitals, there are 8 main health centres and a further 16 smaller centres, 200 plus mobile clinic unit teams as well as the Medical Research Council which is funded by the UK Government.
There are also a number of privately run clinics as well as a few health focused NGOs operating in the Gambia. Health facility coverage is amongst the best in Africa (more than 80% of the population have access). Source
April 2018, prof. dr. Jan M. Keppel Hesselink, pain physician, pharmacologist
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 Kopsky DJ1, Keppel Hesselink JM2. | Phenytoin in topical formulations augments pain reduction of other topically applied analgesics in the treatment of trigeminal neuralgia. | J Clin Anesth. | 2017 May;38:154-155. doi: 10.1016/j.jclinane.2017.01.040. Epub 2017 Feb 17.
 Kopsky DJ1, Keppel Hesselink JM2. | Topical phenytoin for the treatment of neuropathic pain. | J Pain Res. | 2017 Feb 27;10:469-473. doi: 10.2147/JPR.S129749. eCollection 2017.
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