Practical management of patients with painful diabetic neuropathy.
OBJECTIVE
Painful diabetic neuropathy (PDN) has a significant impact on patients' quality of life, affecting sleep, mood, mobility, ability to work, interpersonal relationships, overall self-worth, and independence. The purpose of this article is to provide diabetes educators with current and essential tools for PDN assessment and management.


METHODS
Medline and CINAHL database searches identified publications on the assessment and treatment of PDN. Identified research was evaluated, and information pertinent to diabetes educators was summarized.


RESULTS
Recent advancements in assessment of neuropathic pain include identifying characteristics that distinguish between neuropathic and nonneuropathic pain. In the absence of treatment, research demonstrates that nerve damage may progress while pain diminishes. Many disease-modifying and symptom-management treatment options are available.


CONCLUSIONS
Good glycemic control is the first priority for both prevention and management of PDN. However, even with good glycemic control, up to 20% of patients will develop PDN. PDN recognition and assessment are critical to optimize management. Although several treatment modalities are available, few patients obtain complete pain relief. Recent advances in understanding the mechanisms underlying neuropathic pain should lead to better treatment and patient outcomes. Combination therapy, including nonpharmacologic modalities, may be required. Research evaluating the efficacy of combination therapy is needed.
Corbett
Cynthia F
CF
Intercollegiate College of Nursing, Washington State University, 2917 West Fort George Wright Drive, Spokane, Washington 99224, USA. corbett@wsu.edu
D026881:Acupuncture; D000700:Analgesics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D002986:Clinical Trials as Topic; D016206:Databases, Bibliographic; D003929:Diabetic Neuropathies / Q000503:physiopathology* / Q000534:rehabilitation; D004558:Electric Stimulation; D006801:Humans; D010146:Pain / Q000503:physiopathology*; D059408:Pain Management; D010147:Pain Measurement; D010353:Patient Education as Topic
D000700:Analgesics; D000928:Antidepressive Agents