title: Consensus guidelines: treatment planning and options. Diabetic peripheral neuropathic pain.
abstract: Despite the number of patients affected by diabetic peripheral neuropathic pain (DPNP), little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices. Theories about the causes of DPNP are inextricably linked with the causes of diabetic neuropathles, yet most patients with such neuropathies do not experience pain. The factors that differentiate patients with pain from those without remain unknown and are the subject of much research. When choosing treatment for patients with DPNP, physicians are confronted with a myriad of choices, none of which has been shown to be effective for all patients. This article reviews the evidence for these treatments and attempts to guide physicians in choosing those treatments based on evidence from well-designed clinical trials to support their use. Two agents, duloxetine and pregabalin, are formally approved by the Food and Drug Administration for the treatment of DPNP. In addition, several other agents, including the tricyclic class of antidepressants, have been effective in clinical trials. Ultimately, treatment choice must also Include consideration of adverse effects, individual patient factors such as comorbidities, and often cost.
authors.affiliation: New York University School of Medicine and Cohn Pain Management Center, North Shore University Hospital, Manhasset, NY, USA.
authors.forename: Charles E
authors.initials: CE
authors.lastname: Argoff
authors.forename: Misha-Miroslav
authors.initials: MM
authors.lastname: Backonja
authors.forename: Miles J
authors.initials: MJ
authors.lastname: Belgrade
authors.forename: Gary J
authors.initials: GJ
authors.lastname: Bennett
authors.forename: Michael R
authors.initials: MR
authors.lastname: Clark
authors.forename: B Eliot
authors.initials: BE
authors.lastname: Cole
authors.forename: David A
authors.initials: DA
authors.lastname: Fishbain
authors.forename: Gordon A
authors.initials: GA
authors.lastname: Irving
authors.forename: Bill H
authors.initials: BH
authors.lastname: McCarberg
authors.forename: Michael J
authors.initials: MJ
authors.lastname: McLean
mesh_terms: D000701:Analgesics, Opioid / Q000627:therapeutic use; D000779:Anesthetics, Local / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D017410:Practice Guidelines as Topic
chemical_list: D000701:Analgesics, Opioid; D000779:Anesthetics, Local; D000927:Anticonvulsants; D000928:Antidepressive Agents