Treatment of symptomatic diabetic neuropathy

Abstract

Painful diabetic neuropathy is a common and particularly unpleasant long-term complication of diabetes that affects a significant minority of patients with distal polyneuropathy. After exclusion of other causes of neuropathic pain, attention should be focused on achieving optimal and stable glycaemic control avoiding flux of blood glucose levels, which have been shown to aggravate pain. Most patients will require pain control therapy and whilst the tricyclic drugs remain a first-line approach, their use is often hampered by predictable but troublesome side effects. Gabapentin, the only agent specifically licensed for the treatment of neuropathic pain in the United Kingdom, is useful in diabetic neuropathy and is generally better tolerated than the tricyclics. Additionally, other pharmacological and non-pharmacological pain management approaches may be useful. Patient education has a significant role to play in the avoidance of late neurological complications.