Interventional Therapies for Painful Diabetic Peripheral Neuropathy

Abstract

Painful diabetic peripheral neuropathy (DPN) is a common finding in diabetic patients with disease of long duration and is a significant cause of increased morbidity and mortality in this patient population. It is estimated that 50 % of diabetic patients with long duration disease will develop DPN and of those with DPN, half will develop painful neuropathic symptoms [1]. First-line oral pharmacotherapy for painful DPN involves the use of anticonvulsants, tricyclic antidepressants, and/or serotonin and norepinephrine reuptake inhibitors [1]. Unfortunately, these medications don’t work in many patients and provide only modest improvement in painful symptoms in those patients who do get benefit. Some patients who do receive benefit ultimately discontinue therapy due to side effects. As a result, pain specialists have turned to more aggressive and invasive therapies for patients who are refractory to medical management. As with other sources of chronic non-malignant pain these therapies are reserved for more severe cases and may require more careful screening to ensure the risk versus benefit ratio is favorable for each individual patient. In the treatment of painful DPN there are primarily three interventional treatments that have been employed. These include dorsal column spinal cord stimulation, the application of a capsaicin 8 % topical patch, and intrathecal drug delivery via an implantable pump system.