title: Understanding and treating painful diabetic neuropathy: time for a paradigm shift.
abstract: The pathogenesis of diabetic neuropathy (DN) continues to be unclear and as a result, progress in developing effective therapies has been disappointing. In particular, there is only limited understanding of why some patients suffer severe chronic pain, whilst others have painless symptoms. Assessment of the peripheral nerves frequently shows no differences between painful and painless DN. There is growing evidence that the nerve damage in DN is more generalized, including the central nervous system, and these central changes are key to the development and persistence of pain in DN. The advent of new radiological techniques provides us with non-invasive modalities to study central pathophysiological processes in greater detail. These insights are increasingly leading to the recognition that painful DN is a complex and heterogeneous disorder, which requires a multimodal approach to treatment.
authors.affiliation: Academic Unit of Diabetes, Endocrinology and Metabolism, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: R A
authors.initials: RA
authors.lastname: Gandhi
authors.affiliation: Academic Unit of Diabetes, Endocrinology and Metabolism, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: D
authors.initials: D
authors.lastname: Selvarajah
mesh_terms: D002490:Central Nervous System / Q000502:physiology; D059350:Chronic Pain / Q000453:epidemiology / Q000209:etiology / Q000628:therapy; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D006801:Humans; D009437:Neuralgia / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D015990:Placebo Effect