Treating diabetic peripheral neuropathic pain.
Diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10 to 20 percent of patients with diabetes mellitus. Treatment goals include restoring function and improving pain control. Patients can realistically expect a 30 to 50 percent reduction in discomfort with improved functionality. The main classes of agents used to treat diabetic peripheral neuropathic pain include tricyclic antidepressants, anticonvulsants, serotonin-norepinephrine reuptake inhibitors, opiates and opiate-like substances, and topical medications. Physicians should ask patients whether they have tried complementary and alternative medicine therapies for their pain. Only two medications are approved specifically for the treatment of diabetic peripheral neuropathic pain: pregabalin and duloxetine. However, evidence supports the use of other therapies, and unless there are contraindications, tricyclic antidepressants are the first-line treatment. Because patients often have multiple comorbidities, physicians must consider potential adverse effects and possible drug interactions before prescribing a medication.
Lindsay
Tammy J
TJ
St. Louis University Family Medicine Residency Program, Belleville, IL 62220, USA. tammy.lindsay@us.af.mil
Rodgers
Blake C
BC
Savath
Vincent
V
Hettinger
Kevin
K
D000701:Analgesics, Opioid / Q000627:therapeutic use; D000927:Anticonvulsants / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000627:therapeutic use; D000529:Complementary Therapies; D003929:Diabetic Neuropathies / Q000150:complications / Q000188:drug therapy* / Q000503:physiopathology; D004347:Drug Interactions; D004359:Drug Therapy, Combination; D000068736:Duloxetine Hydrochloride; D006801:Humans; D010146:Pain / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology; D010147:Pain Measurement; D000069583:Pregabalin; D020127:Recovery of Function; D013876:Thiophenes / Q000627:therapeutic use; D005680:gamma-Aminobutyric Acid / Q000031:analogs & derivatives / Q000627:therapeutic use
D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents; D013876:Thiophenes; D000069583:Pregabalin; D005680:gamma-Aminobutyric Acid; D000068736:Duloxetine Hydrochloride