New perspectives on the management of diabetic peripheral neuropathic pain.
Peripheral neuropathy affects about 30% of people with diabetes mellitus. Between 16% and 26% of diabetes patients experience chronic pain. This may be referred to as diabetic neuropathic pain (DNP) or diabetic peripheral neuropathic pain (DPNP). Minimum requirements for diagnosis of DPNP should include assessment of pain and symptoms and neurological examination, with the accent on sensory examination. Given that depression and other co-morbidities are commonly associated with this condition, a broad approach to management is essential. Lifestyle intervention and optimisation of glycaemic control are recommended as initial steps in management. An evidence-based treatment algorithm for DPNP has been proposed, recommending initial use of either a tricyclic antidepressant, selective serotonin noradrenaline re-uptake inhibitor or alpha-2-delta agonist, depending on patient co-morbidities and contra-indications. Addition of an opioid agonist may be required in the event of inadequate pain control. Irrespective of which treatment is offered, only about one third of patients are likely to achieve more than 50% pain relief. Further research to improve the diagnosis and management of DPNP is needed.
Jensen
Troels S
TS
Department of Endocrinology, Diabetology and Nutrition, Hôpital Jean-Verdier APHP Paris-Nord University, Bondy, France. tsjensen@ki.au.dk
Backonja
Misha-Miroslav
MM
Hernández Jiménez
Sergio
S
Tesfaye
Solomon
S
Valensi
Paul
P
Ziegler
Dan
D
D000927:Anticonvulsants / Q000494:pharmacology / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D010146:Pain / Q000175:diagnosis / Q000188:drug therapy*; D015995:Prevalence; D017367:Selective Serotonin Reuptake Inhibitors / Q000494:pharmacology / Q000627:therapeutic use
D000927:Anticonvulsants; D017367:Selective Serotonin Reuptake Inhibitors