Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management
Open accessAbstract
Painful diabetic peripheral neuropathy (DPN) is common, is associated with significant reduction in quality of life and poses major treatment challenges to the practising physician. Although poor glucose control and cardiovascular risk factors have been proven to contribute to the aetiology of DPN, risk factors specific for painful DPN remain unknown. A number of instruments have been tested to assess the character, intensity and impact of painful DPN on quality of life, activities of daily living and mood. Management of the patient with DPN must be tailored to individual requirements, taking into consideration the co‐morbidities and other factors. Pharmacological agents with proven efficacy for painful DPN include tricyclic anti‐depressants, the selective serotonin and noradrenaline re‐uptake inhibitors, anti‐convulsants, opiates, membrane stabilizers, the anti‐oxidant alpha‐lipoic acid and topical agents including capsaicin. Current first‐line therapies for painful DPN include tricyclic anti‐depressants, the serotonin and noradrenaline re‐uptake inhibitor duloxetine and the anti‐convulsants pregabalin and gabapentin. When prescribing any of these agents, other co‐morbidities and costs must be taken into account. Second‐line approaches include the use of opiates such as synthetic opioid tramadol, morphine and oxycodone‐controlled release. There is a limited literature with regard to combination treatment. In extreme cases of painful DPN unresponsive to pharmacotherapy, occasional use of electrical spinal cord stimulation might be indicated. There are a number of unmet needs in the therapeutic management of painful DPN. These include the need for randomized controlled trials with active comparators and data on the long‐term efficacy of agents used, as most trials have lasted for less than 6 months. Finally, there is a need for appropriately designed studies to investigate non‐pharmacological approaches. Copyright © 2011 John Wiley & Sons, Ltd.
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Other diabetic neuropathies include mononeuritis such as cranial nerve palsies and entrapment neuropathies.
“Other forms of diabetic neuropathies are mononeuritis such as cranial nerve palsies or entrapment neuropathies (eg, carpal tunnel syndrome, ulnar entrapment, and peroneal entrapment, among others).632–635”
From American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. (2022) · cites this paper as [633]
The Introduction (p. 2) describes entrapments as conditions that can masquerade as neuropathy, rather than as forms of diabetic neuropathy. The assessment section (p. 3) likewise says to exclude entrapment syndromes when diagnosing painful diabetic peripheral neuropathy. The cited passages do not address cranial nerve palsies or the named entrapment examples. (LLM, conf=0.75)
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- Authors
- Tesfaye, S., Vileikyte, L., Rayman, G., Sindrup, S. H., Perkins, B. A., Baconja, M., Vinik, A. I., Boulton, A. J. M., & Neuropathy, O. B. O. T. T. E. P. O. D.
- Affiliations
- Royal Hallamshire Hospital (GB)
- Ipswich Hospital (GB)
- Odense University Hospital (DK)
- University of Toronto (CA)
- University of Wisconsin–Madison (US)
- Eastern Virginia Medical School (US)
- University of Manchester (GB)
- Corresponding author
- Boulton, A. J. M.
- Venue
- Diabetes/Metabolism Research and Reviews
- Publisher
- Wiley
- Published
- 2011-10
- Volume
- 27
- Issue
- 7
- Pages
- 629-638
- ISSN
- 1520-7552 (ISSN-L)
- 1520-7560
- OpenAlex
- W2008600729
- Cited by
- 410
- References
- 59
- Citations by year
- 2026: 15 · 2025: 13 · 2024: 21 · 2023: 31 · 2022: 42 · 2021: 37 · 2020: 31 · 2019: 33 · 2018: 34 · 2017: 21 · 2016: 23 · 2015: 31 · 2014: 35 · 2013: 29 · 2012: 12
- FWCI
- 16.73
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Diabetes/Metabolism Research and Reviews (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Oncology › Cancer Treatment and Pharmacology
- Keywords
- diabetic neuropathic pain, neuropathic pain, diabetes mellitus, quality of life, pain assessment, tricyclic antidepressants, duloxetine, pregabalin, gabapentin, antiepileptic drugs, opiates, tramadol, spinal cord stimulation, alpha-lipoic acid, capsaicin, combination therapy, pharmacological management
- MeSH terms
- Activities of Daily Living, Analgesics, Anticonvulsants, Antidepressive Agents, Diabetic Neuropathies, Humans, Pain, Quality of Life, Disease Management, Consensus
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