title: Painful diabetic neuropathy: diagnosis and management.
abstract: The prevalence of painful diabetic peripheral neuropathy (PDN) is about 20% in patients with type 2 diabetes and 5% in those with type 1. Patients should be systematically questioned concerning suggestive symptoms, as they are not usually volunteers. As PDN is due to small-fibre injury, the 10 g monofilament pressure test as well as the standard electrophysiological procedures may be normal. Diagnosis is based on clinical findings: type of pain (burning discomfort, electric shock-like sensation, aching coldness in the lower limbs); time of occurrence (mostly at rest and at night); and abnormal sensations (such as tingling or numbness). The DN4 questionnaire is an easy-to-use validated diagnostic tool. Three classes of drugs are of equal value in treating PDN: tricyclic antidepressants; anticonvulsants; and selective serotonin-reuptake inhibitors. These compounds may be prescribed as first-line therapy following pain assessment using a visual analogue scale. If the initial drug at its maximum tolerated dose does not lead to a decrease in pain of at least 30%, another drug class should be prescribed; if the pain is decreased by 30% but remains greater than 3/10, a drug from a different class may be given in association.
authors.affiliation: Service de Diabétologie, Hôpital de la Pitié, AP-HP, Université Pierre-et-Marie-Curie, 83, boulevard de l'Hôpital, 75013 Paris, France. agnes.hartemann@psl.aphp.fr
authors.forename: A
authors.initials: A
authors.lastname: Hartemann
authors.forename: N
authors.initials: N
authors.lastname: Attal
authors.forename: D
authors.initials: D
authors.lastname: Bouhassira
authors.forename: I
authors.initials: I
authors.lastname: Dumont
authors.forename: H
authors.initials: H
authors.lastname: Gin
authors.forename: S
authors.initials: S
authors.lastname: Jeanne
authors.forename: G
authors.initials: G
authors.lastname: Said
authors.forename: J-L
authors.initials: JL
authors.lastname: Richard
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D003929:Diabetic Neuropathies / Q000175:diagnosis* / Q000188:drug therapy* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D015995:Prevalence; D017367:Selective Serotonin Reuptake Inhibitors / Q000627:therapeutic use*
chemical_list: D000700:Analgesics; D017367:Selective Serotonin Reuptake Inhibitors