title: Alleviation of pain in painful diabetic neuropathy.
abstract: BACKGROUND
  Painful diabetic neuropathy (PDN) is a disabling pain condition. Its pathomechanism remains unknown, but a sensitization and neuronal hyperexcitabilty have been suggested. Only symptomatic pharmacological pain management treatment is currently available.
  
  
  METHODS
  The origin of PDN is enigmatic, and the evidence-based therapeutic guidelines therefore consist only of antidepressants and antiepileptics as first-line recommended drugs. This article relates to a MEDLINE/PubMed systematic search (2005-2015).
  
  
  CONCLUSIONS
  The results of the meta-analysis from the aspect of the efficacy of amitriptyline, duloxetine, venlafaxine, gabapentin and pregabalin are favorable, but the placebo response rate is relatively high in patients with neuropathic pain. For personalization of the medication of PDN patients, the optimum dosing, the genotyping of the metabolizing enzymes and optimum biomarkers are needed. As concerns the future perspectives, specific sodium channel subtype inhibitors acting on peripheral nociceptive neurons or modified T-type voltage-gated calcium channel blockers may be promising targets for pharmaceutical innovations. Another attractive strategy for the treatment is based on the effects of monoclonal antibodies against nerve growth factor, sodium channels, specific receptor and cytokines. Botulinum toxin A, capsaicin patch and spinal cord stimulation therapies are the nearest future therapeutic options for the treatment of PDN patients.
authors.affiliation: a Department of Neurology, Faculty of Medicine , University of Szeged , Szeged , Hungary.
authors.forename: János
authors.initials: J
authors.lastname: Tajti
authors.affiliation: a Department of Neurology, Faculty of Medicine , University of Szeged , Szeged , Hungary.
authors.forename: Délia
authors.initials: D
authors.lastname: Szok
authors.affiliation: a Department of Neurology, Faculty of Medicine , University of Szeged , Szeged , Hungary.
authors.forename: Zsófia
authors.initials: Z
authors.lastname: Majláth
authors.affiliation: a Department of Neurology, Faculty of Medicine , University of Szeged , Szeged , Hungary.
authors.forename: Anett
authors.initials: A
authors.lastname: Csáti
authors.affiliation: a Department of Neurology, Faculty of Medicine , University of Szeged , Szeged , Hungary.
authors.forename: Anna
authors.initials: A
authors.lastname: Petrovics-Balog
authors.affiliation: a Department of Neurology, Faculty of Medicine , University of Szeged , Szeged , Hungary.|b MTA - SZTE Neuroscience Research Group , Szeged , Hungary.
authors.forename: László
authors.initials: L
authors.lastname: Vécsei
mesh_terms: D000700:Analgesics / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000927:Anticonvulsants / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000503:physiopathology; D004305:Dose-Response Relationship, Drug; D015195:Drug Design; D006801:Humans; D017410:Practice Guidelines as Topic; D057285:Precision Medicine
chemical_list: D000700:Analgesics; D000911:Antibodies, Monoclonal; D000927:Anticonvulsants; D000928:Antidepressive Agents
keywords: Antidepressants; antiepileptics; diabetes; metabolism; painful neuropathy; pharmacodynamics; pharmacokinetics; treatment