title: Evidence-based guideline: Treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation.
abstract: OBJECTIVE
  To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN).
  
  
  METHODS
  We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; and 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?"
  
  
  CONCLUSIONS
  Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulphate, 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, and few studies have sufficient information on treatment effects on function and QOL.
authors.forename: Vera
authors.initials: V
authors.lastname: Bril
authors.forename: John
authors.initials: J
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
authors.initials: J
authors.lastname: Cohen
authors.forename: David
authors.initials: D
authors.lastname: Del Toro
authors.forename: Eva
authors.initials: E
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
authors.initials: D
authors.lastname: Zochodne
mesh_terms: D000047:Academies and Institutes; D003928:Diabetic Nephropathies / Q000150:complications / Q000175:diagnosis / Q000534:rehabilitation; D004568:Electrodiagnosis; D019317:Evidence-Based Medicine; D006801:Humans; D009462:Neurology; D010146:Pain / Q000175:diagnosis / Q000209:etiology / Q000534:rehabilitation; D026761:Physical Therapy Specialty; D017410:Practice Guidelines as Topic; D012955:Societies, Medical; D014481:United States