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New perspectives on the management of diabetic peripheral neuropathic pain

Department of Neurology, Danish Pain Research Center, Faculty of Health Sciences, University of Aarhus, Denmark.

Misha-Miroslav Backonja

UW-Neurology Pain Clinic, H6/5 Clinical Science Center, Madison, Wisconsin, USA.

Sergio Hernández Jiménez

Department of Endocrinology and Metabolism, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, México.

Solomon Tesfaye

Diabetes Research Unit, University of Sheffield, Royal Hallamshire Hospital, Sheffield, UK.

Paul Valensi

Department of Endocrinology, Diabetology and Nutrition, Hôpital Jean-Verdier APHP, Paris-Nord University, Bondy, France.

Dan Ziegler

German Diabetes Clinic, German Diabetes Center, Leibniz Center at the Heinrich Heine University Düsseldorf, Germany.

Peripheral neuropathy affects about 30% of people with diabetes mellitus. Between 16% and 26% of diabetes patients experience chronic pain. This may be referred to as diabetic neuropathic pain (DNP) or diabetic peripheral neuropathic pain (DPNP). Minimum requirements for diagnosis of DPNP should include assessment of pain and symptoms and neurological examination, with the accent on sensory examination. Given that depression and other co-morbidities are commonly associated with this condition, a broad approach to management is essential. Lifestyle intervention and optimisation of glycaemic control are recommended as initial steps in management.

An evidence-based treatment algorithm for DPNP has been proposed, recommending initial use of either a tri-cyclic antidepressant, selective serotonin noradrenaline re-uptake inhibitor or alpha-2-delta agonist, depending on patient co-morbidities and contra-indications. Addition of an opioid agonist may be required in the event of inadequate pain control. Irrespective of which treatment is offered, only about one third of patients are likely to achieve more than 50% pain relief. Further research to improve the diagnosis and management of DPNP is needed.

Key Words: diabetic peripheral neuropathic pain • management • pathogenesis • serotonin noradrenaline reuptake inhibitor • treatment algorithm

Diabetes and Vascular Disease Research, Vol. 3, No. 2, 108-119 (2006)
DOI: 10.3132/dvdr.2006.013


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