Characteristics and Treatment of Painful Diabetic Neuropathy

Abstract

The most common of painful diabetic neuropathies is painful polyneuropathy, affecting up to 50% of patients with polyneuropathy. The risk factors for developing neuropathic pain in those with diabetic polyneuropathy are largely unknown. Increasing evidence point toward an association between pain and neuropathy severity, but studies also suggest that other risk factors, such as female sex and high HbA1c, are also involved. The symptoms of painful diabetic polyneuropathy can be a shooting, squeezing, or burning pain in the feet, often together with other abnormal sensations, such as numbness or pins and needles. The diagnosis of painful diabetic neuropathy is primarily clinical, consisting of evaluation of symptoms and signs, and can be confirmed with abnormal nerve conduction studies or intraepidermal nerve fiber density. The management of painful diabetic polyneuropathy consists of symptomatic pain treatment including nonpharmacological treatment, such as pain education, physiotherapy, and psychological treatment and pharmacological treatment to improve quality of life. According to guideline recommendations, pregabalin and gabapentin, tricyclic antidepressants, and serotonin noradrenaline reuptake inhibitors are recommended as a first-line therapy with a strong recommendation and moderate to high quality of evidence. Effect sizes are moderate and not all patients experience an effect in tolerated doses and often combination treatment and a multidisciplinary approach to treatment is needed.