Abstract

Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.

Highlights

  • Diabetic neuropathy is one of the most common chronic complications of diabetes mellitus [1].It is defined as the presence of signs and/or symptoms of nerve dysfunction in patients with diabetes mellitus after exclusion of other causes [1,2]

  • We performed a review of the literature starting from 1990 by searching PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases for all observational studies, randomized clinical trials, and meta-analyses including the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”, as well as their combinations regarding DSPN

  • In a post-hoc analysis of the BARI 2D clinical trial (Bypass Angioplasty Revascularization Investigation in Type 2 Diabetes), subjects treated with insulin sensitizers exhibited a reduced incidence of DSPN at 4 years, as compared with those receiving insulin or sulphonylureas [16]

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Summary

Introduction

Diabetic neuropathy is one of the most common chronic complications of diabetes mellitus [1].It is defined as the presence of signs and/or symptoms of nerve dysfunction in patients with diabetes mellitus after exclusion of other causes [1,2]. Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. It is usually characterized by progressive sensory loss, some patients may develop chronic pain. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. Multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice

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