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

Neurology (Impact Factor: 8.29). 05/2011; 76(20):1758-65. DOI: 10.1212/WNL.0b013e3182166ebe


To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN).

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.

12 Reads
    • "There are unmet needs in the treatment of painful diabetic neuropathy [4], and medications with different mechanisms of action and improved efficacy/safety profiles may provide useful options. T-type calcium channels represent a potential novel target for pain modulation. "
    [Show abstract] [Hide abstract]
    ABSTRACT: T-type calcium channels are a potential novel target for treatment of neuropathic pain such as painful diabetic neuropathy. ABT-639 is a peripherally acting, highly selective, T-type Cav3.2 calcium channel blocker that has demonstrated analgesic efficacy in preclinical models and may have the potential to reduce spontaneous fiber activity. Microneurography is a unique technique that directly assesses the function of peripheral sensory afferents and measures abnormal spontaneous activity in single peripheral nociceptive C-fibers. Abnormal spontaneous activity in C-nociceptors functions as a marker for spontaneous pain, as reduction of this activity could indicate analgesic efficacy. This randomized, double-blind, controlled study evaluated the effects of a single, 100-mg oral dose of ABT-639, compared with placebo, on abnormal spontaneous activity in peripheral C-nociceptors, measured for the first time by microneurography in adult patients with painful diabetic neuropathy. Lidocaine was included in this study and compared with placebo. Pharmacokinetics and safety of ABT-639 were evaluated. Thirty-nine patients were randomized and a total of 56 analyzable C-nociceptors with spontaneous activity were identified in 34 patients. There were no significant differences in C-nociceptor activities after ABT-639 treatment vs placebo. Similar findings were observed for lidocaine vs placebo. There were no clinically significant findings in the safety of ABT-639. Further research of T-type Cav3.2 calcium channels as potential treatment targets for painful diabetic neuropathy is warranted. The utilization of microneurography as a means to measure abnormal activity in C-nociceptors in human clinical studies opens new possibilities for future studies of compounds targeting peripheral nerve hyperexcitability. identifier: NCT01589432.
    Pain 05/2015; DOI:10.1097/j.pain.0000000000000249 · 5.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Myofascial pain syndrome (MPS) is a common musculoskeletal pain syndrome characterized by acute or chronic regional muscle pain. MPS is primarily caused by myofascial trigger points (MTrP). MPS treatment consists of MTrP inactivation, which breaks the vicious cycle of pain-contracture-pain and activates the descending pain inhibitory system. In recent years, low-level laser therapy (LLLT) has become an increasingly mainstream modality for pain control of MPS and MTrP; however, the clinical outcomes of LLLT in MPS and MTrP seem controversial. This can probably be explained by the various parameters and applications of LLLT. Therefore, to discuss the effects of LLLT on MPS and MTrP, this review addresses the possible mechanisms of LLLT that operate both on cellular and tissue levels. The current literature suggests that LLLT may offer an important adjunct and non-drug option in general practices for MPS patients, especially in patients with adverse side effects to drug and invasive treatments.
    Critical Reviews in Physical and Rehabilitation Medicine 01/2010; 22(1-4):241-277. DOI:10.1615/CritRevPhysRehabilMed.v22.i1-4.110
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To assess, in the general diabetic population, 1) the prevalence of painful neuropathic symptoms; 2) the relationship between symptoms and clinical severity of neuropathy; and 3) the role of diabetes type, sex, and ethnicity in painful neuropathy. Observational study of a large cohort of diabetic patients receiving community-based health care in northwest England (n = 15,692). Painful diabetic neuropathy (PDN) was assessed using neuropathy symptom score (NSS) and neuropathy disability score (NDS). Prevalence of painful symptoms (NSS ≥5) and PDN (NSS ≥5 and NDS ≥3) was 34 and 21%, respectively. Painful symptoms occurred in 26% of patients without neuropathy (NDS ≤2) and 60% of patients with severe neuropathy (NDS >8). Adjusted risk of painful neuropathic symptoms in type 2 diabetes was double that of type 1 diabetes (odds ratio [OR] = 2.1 [95% CI 1.7-2.4], P < 0.001) and not affected by severity of neuropathy, insulin use, foot deformities, smoking, or alcohol. Women had 50% increased adjusted risk of painful symptoms compared with men (OR = 1.5 [1.4-1.6], P < 0.0001). Despite less neuropathy in South Asians (14%) than Europeans (22%) and African Caribbeans (21%) (P < 0.0001), painful symptoms were greater in South Asians (38 vs. 34 vs. 32%, P < 0.0001). South Asians without neuropathy maintained a 50% increased risk of painful neuropathy symptoms compared with other ethnic groups (P < 0.0001). One-third of all community-based diabetic patients have painful neuropathy symptoms, regardless of their neuropathic deficit. PDN was more prevalent in patients with type 2 diabetes, women, and people of South Asian origin. This highlights a significant morbidity due to painful neuropathy and identifies key groups who warrant screening for PDN.
    Diabetes care 08/2011; 34(10):2220-4. DOI:10.2337/dc11-1108 · 8.42 Impact Factor
Show more