Pharmacotherapy of Painful Diabetic Neuropathy: A Clinical Update

Abstract

T he current global prevalence of diabetes mellitus (DM) among adults (aged 20-70 years) is 537 million (one in every ten adults) that is expected to raise to 643 million by the year 2030, and 783 million by the year 2045. [1] The increasing prevalence of DM has led to a rise in chronic diabetic complications. Diabetic peripheral neuropathies (DPNs) are the most common chronic complications of diabetes. [2] Among these, the distal symmetric polyneuropa-thy (DSPN) is the most prevalent form which may affect up to 50% of patients with type 2 DM (T2DM) after 10 years of the disease, and at least 20% with type 1 DM (T1DM) after 20 years of the disease. [3] Furthermore, nearly 10-15% of newly diagnosed T2DM may have DSPN.Although a vast majority of patients with DPN may remain pain-free, painful DPN (PDPN) is estimated to affect 6-34% of all patients with DM. [4] The disease burden from PDPN The rising prevalence of diabetes mellitus (DM) leads on to an increase in chronic diabetic complications. Diabetic peripheral neuropathies (DPNs) are common chronic complications of diabetes. Distal symmetric polyneuropathy is the most prevalent form. Most patients with DPN will remain pain-free; however, painful DPN (PDPN) occurs in 6-34% of all DM patients and is associated with reduced health-related-quality-of-life and substantial economic burden. Symptomatic treatment of PDPN and diabetic autonomic neuropathy is the key treatment goals. Using certain patient related characteristics, subjects with PDPN can be stratified and assigned targeted therapies to produce better pain outcomes. The aim of this review is to discuss the various pathogenetic mechanisms of DPN with special reference to the mechanisms leading to PDPN and the various pharmacological and non-pharmacological therapies available for its management. Recommended pharmacological therapies include anticonvulsants, antidepressants, opioid analgesics, and topical medications.

Update on Treating Painful Diabetic Peripheral Neuropathy: A Review of Current US Guidelines with a Focus on the Most Recently Approved Management Options

“…The management of painful DPN involves controlling the underlying diabetic condition and symptomatically treating the associated pain, as recommended in multiple clinical practice guidelines and expert reviews. [8][9][10][18][19][20][21][22][23][24][26][27][28][29] Given their influence and importance in determining recommendations in other relevant expert opinions and reviews, [8][9][10][22][23][24]28,29 we have focused on evidence-based guidelines and recommended treatment algorithms from the following US organizations:…”

“…17 The management of painful DPN involves treating the underlying causes via lifestyle modifications and pharmacological control of risk factors, targeting its pathogenesis, and providing symptomatic pain relief, thereby improving patient function and health-related quality of life (HR-QoL). [8][9][10][18][19][20][21][22][23][24] Despite the substantial morbidity of painful DPN, its negative impact on HR-QoL, and immense healthcare burden, the condition is often misdiagnosed and inadequately treated. 8,14,25 Since 2020, the US Food and Drug Administration (FDA) has approved two novel options to manage painful DPN, namely the capsaicin 8% topical system and spinal cord stimulation devices.…”