Treatment of Painful Diabetic Neuropathy-A Narrative Review of Pharmacological and Interventional Approaches.

Mayank Gupta,Kiran Patel,Bhavika Chowdhury,Alaa Abd-Elsayed,Nebojsa Nick Knezevic,Mahoua Ray

doi:10.3390/biomedicines9050573

Abstract

Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus that is associated with a significant decline in quality of life. Like other painful neuropathic conditions, PDN is difficult to manage clinically, and a variety of pharmacological and non-pharmacological options are available for this condition. Recommended pharmacotherapies include anticonvulsive agents, antidepressant drugs, and topical capsaicin; and tapentadol, which combines opioid agonism and norepinephrine reuptake inhibition, has also recently been approved for use. Additionally, several neuromodulation therapies have been successfully used for pain relief in PDN, including intrathecal therapy, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). Recently, 10 kHz SCS has been shown to provide clinically meaningful pain relief for patients refractory to conventional medical management, with a subset of patients demonstrating improvement in neurological function. This literature review is intended to discuss the dosage and prospective data associated with pain management therapies for PDN.

Highlights

The number of patients living with diabetes mellitus (DM) is growing in the UnitedStates, and the estimated prevalence of this condition rose from 9.5% in 1999–2000 to 12.0%in 2013–2016 [1]
An extended release (ER) formulation of venlafaxine was tested in a 6-week, double-blind, randomized controlled trial (RCT) in 244 subjects with Painful diabetic neuropathy (PDN), and the investigators found that doses from 150 mg to 225 mg/day resulted in 50% lower pain scores than the baseline, which was significantly greater than the 27% pain reduction in the placebo group [41]
Schwartz et al reported a 37% increase in pain scores in subjects switched to placebo and no change in those continuing on tapentadol, a significant difference [47], while the RCT by Vinik et al showed subjects who continued on tapentadol treatment in the double-blind part of the study had significantly less pain (26%) than those who were withdrawn to placebo [48]

Summary

Introduction

The number of patients living with diabetes mellitus (DM) is growing in the UnitedStates, and the estimated prevalence of this condition rose from 9.5% in 1999–2000 to 12.0%in 2013–2016 [1]. Neuropathy, which can produce both painful and non-painful symptoms, is the most common complication of DM [2,3], and the management of neuropathic symptoms has been estimated to comprise 27% of the total annual cost of diabetes care or 9% of all healthcare costs for people with DM [4]. Painful diabetic neuropathy (PDN) has been estimated to affect 20% to 24% of all patients with DM [5], and PDN has been reported in. Pain has been reported in twice as many patients with DM and neuropathic symptoms (60%) than those with DM but no neuropathy (30%) [7]. Like neuropathic pain from all etiologies, PDN is often refractory to treatment and challenging to treat [9], and a variety of strategies are currently employed to manage this condition (Table 1).

Methods

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Discussion

Conclusion