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.

17 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.
    No preview · Article · May 2015 · Pain
  • [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.
    No preview · Article · Jan 2010 · Critical Reviews in Physical and Rehabilitation Medicine
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The American Association of Clinical Endocrinologists/American College of Endocrinology Medical Guidelines for Clinical Practice are systematically developed statements to assist healthcare professionals in medical decision making for specific clinical conditions. Most of the content herein is based on literature reviews. In areas of uncertainty, professional judgment was applied. These guidelines are a working document that reflects the state of the field at the time of publication. Because rapid changes in this area are expected, periodic revisions are inevitable. We encourage medical professionals to use this information in conjunction with their best clinical judgment. The presented recommendations may not be appropriate in all situations. Any decision by practitioners to apply these guidelines must be made in light of local resources and individual patient circumstances.
    Preview · Article · Mar 2011 · Endocrine Practice
Show more