title: Long-Term Outcomes in the Management of Painful Diabetic Neuropathy.
abstract: BACKGROUND
  Painful diabetic neuropathy (PDN) is a frequent complication of diabetes mellitus. Current treatment recommendations are based on short-term trials, generally of ≤3 months' duration. Limited data are available on the long-term outcomes of this chronic disease. The objective of this study was to determine the long-term clinical effectiveness of the management of chronic PDN at tertiary pain centres.
  
  
  METHODS
  From a prospective observational cohort study of patients with chronic neuropathic non-cancer pain recruited from seven Canadian tertiary pain centres, 60 patients diagnosed with PDN were identified for analysis. Data were collected according to Initiative on Methods, Measurement, and Pain Assessment in Clinical Trials guidelines including the Brief Pain Inventory.
  
  
  RESULTS
  At 12-month follow-up, 37.2% (95% confidence interval [CI], 23.0-53.3) of 43 patients with complete data achieved pain reduction of ≥30%, 51.2% (95% CI, 35.5-66.7) achieved functional improvement with a reduction of ≥1 on the Pain Interference Scale (0-10, Brief Pain Inventory) and 30.2% (95% CI, 17.2-46.1) had achieved both these measures. Symptom management included at least two medication classes in 55.3% and three medication classes in 25.5% (opioids, antidepressants, anticonvulsants).
  
  
  CONCLUSIONS
  Almost one-third of patients being managed for PDN in a tertiary care setting achieve meaningful improvements in pain and function in the long term. Polypharmacy including analgesic antidepressants and anticonvulsants were the mainstays of effective symptom management.
authors.affiliation: 1Department of Clinical Neurological Sciences,Western University,London,Canada.
authors.forename: Lauren M
authors.initials: LM
authors.lastname: Mai
authors.affiliation: 3Department of Anesthesia, Pain Management & Perioperative Medicine,Dalhousie University,Halifax,Canada.
authors.forename: A John
authors.initials: AJ
authors.lastname: Clark
authors.affiliation: 4Department of Wasser Pain Management Centre,University of Toronto,Toronto,Canada.
authors.forename: Allan S
authors.initials: AS
authors.lastname: Gordon
authors.affiliation: 3Department of Anesthesia, Pain Management & Perioperative Medicine,Dalhousie University,Halifax,Canada.
authors.forename: Mary E
authors.initials: ME
authors.lastname: Lynch
authors.affiliation: 2Department of Anesthesia & Perioperative Medicine,Western University,London,Canada.
authors.forename: Pat K
authors.initials: PK
authors.lastname: Morley-Forster
authors.affiliation: 5Department of Anesthesiology,University of Ottawa,Ottawa,Canada.
authors.forename: Howard
authors.initials: H
authors.lastname: Nathan
authors.affiliation: 5Department of Anesthesiology,University of Ottawa,Ottawa,Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Smyth
authors.affiliation: 6Statistical Services,London,Canada.
authors.forename: Larry W
authors.initials: LW
authors.lastname: Stitt
authors.affiliation: 7Fraser Health,Burnaby,Canada.
authors.forename: Cory
authors.initials: C
authors.lastname: Toth
authors.affiliation: 8Alan Edwards Pain Management Unit,McGill University Health Centre,Montreal,Canada.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Ware
authors.affiliation: 1Department of Clinical Neurological Sciences,Western University,London,Canada.
authors.forename: Dwight E
authors.initials: DE
authors.lastname: Moulin
mesh_terms: D000368:Aged; D000701:Analgesics, Opioid / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000627:therapeutic use*; D000928:Antidepressive Agents / Q000627:therapeutic use*; D002170:Canada; D015331:Cohort Studies; D003929:Diabetic Neuropathies / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018710:Pain Clinics; D059408:Pain Management; D010147:Pain Measurement; D016896:Treatment Outcome
chemical_list: D000701:Analgesics, Opioid; D000927:Anticonvulsants; D000928:Antidepressive Agents
keywords: diabetic; long-term; management; neuropathy; outcome; painful