Evidence‐based guideline: Treatment of painful diabetic neuropathy—report of the american association of neuromuscular and electrodiagnostic medicine, the american academy of neurology, and the american academy of physical medicine & rehabilitation

Abstract

The objective of this report was to develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). The basic question that was asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" A systematic review of literature from 1960 to August 2008 was performed, and studies were classified according to the American Academy of Neurology classification of evidence scheme for a therapeutic article. Recommendations were linked to the strength of the evidence. The results indicate that pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence, or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness. Few studies have sufficient information on their effects on function and QOL.

Rethinking chronic pain in a primary care setting

“…[17][18][19][20][21][22] However, several important factors noted in these guidelines and known to most clinicians are not consistently addressed or implemented, particularly in the primary-care setting.…”

Overview of symptoms, pathogenesis, diagnosis, treatment, and prognosis of various acquired polyneuropathies

“…For the treatment of DN, tight glucose control should be preceded [5]. Next, numerous treatments can be applied to reduce pain and other symptoms by DN., antiepileptic drugs (AEDs), tricyclic antidepressants (TCAs), serotoninnorepinephrine reuptake inhibitors (SNRIs), and capsaicin cream can be prescribed for the control of pain in the patients with DN [6,7]. First of all, TCAs including amitriptyline, imipramine, nortriptyline, and desipramine are effective at decreasing painful symptoms but can cause various side effects which are dosage-dependent, so it should be prescribed carefully when done given at higher doses.…”

Peripheral Nervous System Involvement in Diabetes and Role of Rehabilitation

“…Symptom management of neuropathic pain includes use of pregabalin as class A evidence and selective norepinephrine reuptake inhibitors, Tricyclic antidepressants, gabapentin, with opiates considered in the acute phase as class b evidence [48]. This slightly varies from a 2010 Cochrane report indicating Tricyclics being the initial medication based on lowest number needed to treat (1.3-2.4), with pregabalin next, followed by SNRI and gabapentin [49].…”

“…Selective serotonin reuptake inhibitors can help treat with the pain and depression aspects of the disease [40]. Topical medications from over the counter capsaicin to prescription lidocaine or elaborate compounded mixtures are also indicated [48].…”