Clinical approach to the treatment of painful diabetic neuropathy

Abstract

Painful neuropathy is a common and often progressive complication of diabetes. Patients frequently report symptoms of tingling, burning, lancinating pain, hyperesthesia and allodynia. The natural history of the disease may vary from intermittent mild symptoms to severe chronic daily pain; the latter is often associated with diminished quality of life. There are a variety of pharmaceutical agents from different medicinal categories available for the symptomatic treatment of painful diabetic neuropathy, however selecting an agent is often challenging given the breadth of choices and lack of consistent guidelines. As a result, many patients remain untreated or undertreated. This article presents a practical clinical approach to the treatment of pain in diabetic neuropathy. Recommendations for first, second and third line medications are based on specific evidence for the treatment of painful diabetic neuropathy as well as safety, tolerability, drug interactions and cost. Additional topics of discussion include breakthrough pain, opioid use and topical therapies. This review does not comprehensively discuss all possible treatments for painful neuropathy, but provides a systematic approach designed to guide clinicians in tailoring therapies to the individual patient.

Quercetin protects rat dorsal root ganglion neurons against high glucose-induced injury in vitro through Nrf-2/HO-1 activation and NF-κB inhibition

“…Treatments that are currently prescribed to lessen neuropathic pain have undesirable secondary effects and situational variable efficacy [12] . Therefore, researchers are searching for better diabetic neuropathy drug options.…”

Associations between Sensorimotor, Autonomic and Central Neuropathies in Diabetes Mellitus

“…Advanced peripheral diabetic neuropathy classically manifests as chronic progressive thick (Aβ) and thin (Aδ) fiber neuropathy affecting myelinated axons and later affecting also the unmyelinated C-fibers [2,3]. The natural history of the disease varies from intermittent mild symptoms to manifest neuropathic pain, the latter being present in up to one fourth of the patients diminishing their quality of life [4][5][6]. The typical appearance is length dependent sensorimotor neuropathy caused by chronic progressive symmetric deafferentation and Schwann cell degeneration affecting axons of the distal lower extremities [2,7].…”

Identification of Patients with Painful Diabetic Peripheral Neuropathy Who Have a Favorable Cost Profile with Pregabalin Treatment

“…In this regard, the mean dose of pregabalin, which ranged from 155.3 to 165.3 mg across the cohorts, is lower than the therapeutic dose of 300 mg and thus may have contributed to the low rates of adherence, especially relative to duloxetine for which the mean dose, 54.8 mg, approximates the therapeutic dose of 60 mg. Furthermore, the mean doses of gabapentin (698.8 mg) and amitriptyline (32.5 mg) were also substantially lower than the average effective doses, although high doses of the latter drug are also associated with anticholinergic adverse effects. While reports of the relationship between dose and adherence have also been published for duloxetine in pDPN, it is worth identifying factors other than dose level that can be leveraged for improving patient adherence to therapy.…”