title: Evidence-based guideline: treatment of painful diabetic neuropathy--report of the American Association of Neuromuscular and Electrodiagnostic Medicine, the American Academy of Neurology, and the American Academy of Physical Medicine & Rehabilitation.
abstract: The objective of this report was to develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). The basic question that was asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" A systematic review of literature from 1960 to August 2008 was performed, and studies were classified according to the American Academy of Neurology classification of evidence scheme for a therapeutic article. Recommendations were linked to the strength of the evidence. The results indicate that pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence, or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness. Few studies have sufficient information on their effects on function and QOL.
authors.affiliation: University Health Network, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
authors.forename: John D
authors.initials: JD
authors.lastname: England
authors.forename: Gary M
authors.initials: GM
authors.lastname: Franklin
authors.forename: Miroslav
authors.initials: M
authors.lastname: Backonja
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Cohen
authors.forename: David R
authors.initials: DR
authors.lastname: Del Toro
authors.forename: Eva L
authors.initials: EL
authors.lastname: Feldman
authors.forename: Donald J
authors.initials: DJ
authors.lastname: Iverson
authors.forename: Bruce
authors.initials: B
authors.lastname: Perkins
authors.forename: James W
authors.initials: JW
authors.lastname: Russell
authors.forename: Douglas W
authors.initials: DW
authors.lastname: Zochodne
mesh_terms: D000698:Analgesia / Q000379:methods / Q000592:standards; D000700:Analgesics / Q000627:therapeutic use; D003131:Combined Modality Therapy / Q000592:standards* / Q000639:trends*; D003929:Diabetic Neuropathies / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*; D019317:Evidence-Based Medicine / Q000379:methods / Q000592:standards* / Q000639:trends; D006801:Humans; D009422:Nervous System Diseases / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*; D009468:Neuromuscular Diseases / Q000503:physiopathology* / Q000534:rehabilitation / Q000628:therapy*; D014481:United States
chemical_list: D000700:Analgesics