Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
<i>Background and Objectives</i>: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult,...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-01-01
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| Series: | Medicina |
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| Online Access: | https://www.mdpi.com/1010-660X/56/1/25 |
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| author | Valeriu Ardeleanu Alexandra Toma Kalliopi Pafili Nikolaos Papanas Ion Motofei Camelia Cristina Diaconu Manfredi Rizzo Anca Pantea Stoian |
| author_facet | Valeriu Ardeleanu Alexandra Toma Kalliopi Pafili Nikolaos Papanas Ion Motofei Camelia Cristina Diaconu Manfredi Rizzo Anca Pantea Stoian |
| author_sort | Valeriu Ardeleanu |
| collection | DOAJ |
| description | <i>Background and Objectives</i>: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. <i>Materials and Methods</i>: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. <i>Results</i>: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. <i>Conclusions</i>: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice. |
| first_indexed | 2024-03-12T05:51:42Z |
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| institution | Directory Open Access Journal |
| issn | 1010-660X |
| language | English |
| last_indexed | 2024-03-12T05:51:42Z |
| publishDate | 2020-01-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicina |
| spelling | doaj.art-9395e41c8a854b7d82c82ff6bc94b2112023-09-03T05:06:06ZengMDPI AGMedicina1010-660X2020-01-015612510.3390/medicina56010025medicina56010025Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative ReviewValeriu Ardeleanu0Alexandra Toma1Kalliopi Pafili2Nikolaos Papanas3Ion Motofei4Camelia Cristina Diaconu5Manfredi Rizzo6Anca Pantea Stoian7Department of Surgery, University “Dunarea de Jos”, 800008 Galati, RomaniaDepartment of Surgery, University “Dunarea de Jos”, 800008 Galati, RomaniaSecond Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 681 00 Alexandroupolis, GreeceSecond Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 681 00 Alexandroupolis, GreeceDepartment of Surgery, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaInternal Medicine Department, Clinical Emergency Hospital of Bucharest, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, RomaniaBiomedical Department of Internal Medicine and Medical Specialties School of Medicine, University of Palermo, 90133 Palermo, ItalyDiabetes, Nutrition and Metabolic Diseases Department, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania<i>Background and Objectives</i>: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. <i>Materials and Methods</i>: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. <i>Results</i>: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. <i>Conclusions</i>: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.https://www.mdpi.com/1010-660X/56/1/25diabetes mellitusneuropathypainpharmacological treatment |
| spellingShingle | Valeriu Ardeleanu Alexandra Toma Kalliopi Pafili Nikolaos Papanas Ion Motofei Camelia Cristina Diaconu Manfredi Rizzo Anca Pantea Stoian Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review Medicina diabetes mellitus neuropathy pain pharmacological treatment |
| title | Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review |
| title_full | Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review |
| title_fullStr | Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review |
| title_full_unstemmed | Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review |
| title_short | Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review |
| title_sort | current pharmacological treatment of painful diabetic neuropathy a narrative review |
| topic | diabetes mellitus neuropathy pain pharmacological treatment |
| url | https://www.mdpi.com/1010-660X/56/1/25 |
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