Treatment Options for Diabetic Neuropathic Pain
Glycemic control optimization is widely accepted as the first step in managing painful diabetic neuropathy.
In a presentation at PAINWeek 2017, held September 5-9 in Las Vegas, Nevada, Ramon L. Cuevas-Trisan, MD, chief of the physical medicine, rehabilitation & pain management service at West Palm Beach VA Medical Center in Florida, covered the evaluation and management of diabetic peripheral neuropathic (DPN) pain.1
Painful diabetic neuropathy is estimated to affect one-quarter of patients with diabetes, and rates are increasing along with the prevalence of diabetes in the United States — currently approaching 10% of the population, with a 5% annual growth.2,3 Adequate evaluation and diagnosis of DPN pain are essential. “There are no direct diagnosing methods, only indirect examination methods, together with the patient's complaints,” Dr Cuevas-Trisan told Clinical Pain Advisor. Diagnosis is based on the patient's history of neuropathic pain, combined with findings on examination that indicate deficits associated with neuropathy, such as decreased or altered sensation, atrophy, and intermittent or continuous pain with a distal-to-proximal (“stocking-and-glove”) distribution that is often symmetrical and may worsen at night.
- Cuevas-Trisan R. Diabetic peripheral neuropathic pain: evaluating treatment options. Presented at Pain Week 2017; September 5-9, 2017; Las Vegas, Nevada.
- Kaur S, Pandhi P, Dutta P. Painful diabetic neuropathy: an update. Ann Neurosci. 2011; 18(4):168-175. doi:10.5214/ans.0972-7531.1118409
- Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000Research. 2016; 5:F1000 Faculty Rev-738. doi:10.12688/f1000research.7898.1
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- Bril V, England J, Franklin GM, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy. Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2011; 76(20):1758-1765. doi:10.1212/WNL.0b013e3182166ebe
- Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurology. 2017; 88(20):1958-1967. doi:10.1212/WNL.0000000000003882