Painful diabetic polyneuropathy

Xander Zuidema, Bastiaan de Galan, Brigitte Brouwer, Steven Cohen, Sam Eldabe, Charles Argoff, Frank Huygen, Jan Van Zundert*

*Corresponding author for this work

Research output: Contribution to journal(Systematic) Review article peer-review

Abstract

IntroductionPain as a symptom of diabetic polyneuropathy (DPN) significantly lowers quality of life, increases mortality and is the main reason for patients with diabetes to seek medical attention. The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades.MethodsThe literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized.ResultsThe etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra-spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain-phenotyping and genotyping based on patient-specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of "probable PDPN" is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism-based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and/or radiofrequency ablation (SLCN/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise.ConclusionsThe diagnosis of PDPN evolves toward pheno-and genotyping and treatment should be mechanism-based.
Original languageEnglish
Pages (from-to)308-320
Number of pages13
JournalPain Practice
Volume24
Issue number2
Early online dateOct 2023
DOIs
Publication statusPublished - Feb 2024

Keywords

  • anti-neuropathic drugs
  • evidence-based medicine
  • neuropathic pain
  • painful diabetic polyneuropathy
  • spinal cord stimulation
  • SPINAL-CORD STIMULATION
  • PERIPHERAL NEUROPATHIC PAIN
  • DOUBLE-BLIND
  • TREATMENT RESPONSE
  • FOLLOW-UP
  • EFFICACY
  • SAFETY
  • DULOXETINE
  • PREGABALIN
  • MECHANISM

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