Evidence-based guideline: Treatment of painful diabetic neuropathy [RETIRED]: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation
Open accessAbstract
OBJECTIVE: To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). METHODS: We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: "What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?" RESULTS AND RECOMMENDATIONS: Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.
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Earlier recommendations sometimes reached discrepant conclusions because methods for assessing evidence quality were inconsistent.
“prior recommendations sometimes came to discrepant conclusions because of inconsistencies in methods used to assess the quality of evidence (eg,13,15,16).”
From Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis (2015) · cites this paper as [13]
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- R E T I R E D DOI 10.1212/WNL.0b013e3182166ebe 2011;76;1758-1765 Published Online before print April 11, 2011 · DOI
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- CORRECTION Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation In the article "Evidence-based guideline: Treatment of painful diabetic neuropathy: Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation" by V. Bril et al. (Neurology ® 2011;76:1758 -1765), there was an error in the article text regarding the dosage for the number needed to treat (NNT) and an error in the citation of references 7-9. "The NNT for a 50% reduction in pain was 4 at 600 g/day. 7-10 " should read "The NNT for a 50% reduction in pain was 4 at 600 mg/day. 10 " The authors regret the errors.
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- Authors
- Bril, V., England, J., Franklin, G. M., Backonja, M., Cohen, J., Del Toro, D., Feldman, E., Iverson, D. J., Perkins, B., Russell, J. W., & Zochodne, D.
- Affiliations
- University of Maryland, Baltimore (US)
- From the University Health Network (V.B., B.P.), University of Toronto, Toronto, Canada; Department of Neurology (J.E.), LSU School of Medicine, New Orleans, LA; University of Washington (G.M.F.), Seattle; University of Wisconsin (M.B.), Madison; Dartmouth Hitchcock Medical Center (J.C.), Lebanon, NH; Department of PM&R (D.D.), Medical College of Wisconsin, Milwaukee; University of Michigan (E.F.), Ann Arbor; Humboldt Neurological Medical Group, Inc. (D.J.I.), Eureka, CA; Department of Neurology...
- Venue
- Neurology
- Published
- 2011-05-17
- Volume
- 76
- Issue
- 20
- Pages
- 1758-1765
- ISSN
- 0028-3878 (ISSN-L)
- 1526-632X
- PMC
- PMC3100130
- OpenAlex
- W2125761169
- Cited by
- 634
- References
- 51
- Citations by year
- 2026: 15 · 2025: 13 · 2024: 31 · 2023: 24 · 2022: 44 · 2021: 49 · 2020: 36 · 2019: 34 · 2018: 39 · 2017: 40 · 2016: 48 · 2015: 56 · 2014: 59 · 2013: 66 · 2012: 60
- FWCI
- 43.41
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Neurology (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Physiology › Pain Mechanisms and Treatments
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
- Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Opioid Use
- Keywords
- diabetic neuropathic pain, neuropathic pain, antiepileptic drugs, antidepressants, opioids, pregabalin, venlafaxine, duloxetine, amitriptyline, gabapentin, valproic acid, capsaicin, transcutaneous electrical nerve stimulation, low-level laser therapy, magnetic field therapy, quality of life, physical function
- MeSH terms
- Analgesics, Opioid, Anticonvulsants, Antidepressive Agents, Diabetic Neuropathies, Electromagnetic Fields, Electric Stimulation Therapy, Humans, Pain, Evidence-Based Medicine, Pain Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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