Pharmachologic Treatment of Painful Diabetic Neuropathy

Neuropathic pain is defined as "pain occuring as a direct result of a disease or lesion directly affecting somato-sensorial system". Painful diabetic neuropathy (PDN) is a serious complication impairing quality of life of patients. Researchs show that PDN affects approximately 16% of patients with diabetes. An important part of the PDN patients (39% remain without treatment. The diagnosis of neuropathic pain is a clinical diagnosis. Pain can be described by patients as burning, throbbing, numbness, tingling, anesthetic, pins and needles or blunt pain. Neuropathic pain is accompanied by sensory disorders such as dysesthesia, allodynia (pain heard by a stimulus not creating pain) or hyperalgesia (reduction of pain threshold for a painful stimulus). PDN develops in almost half of diabetic patients within the first ten years of diabetes. Over time, muscle loss, decreased deep tendon reflexes and trophic skin changes can be observed. Treatment guidelines agree that some agents such as pregabalin, gabapentin, tricyclic antidepressants should be preferred in the first line and have controversial proposals for some agents such as duloxetine. This shows the need for more research on the issue. It is important for all physicians dealing with pain, to recognize PDN and prefer evidence-based treatment approaches for patient benefit. In this revievvi pharmacological treatment of PDN is discussed in light of current research and treatment guidelines.