, Volume 67, Issue 4, pp 569–585 | Cite as

Diabetic Painful Neuropathy

Current and Future Treatment Options
  • M. Sam Chong
  • Joan Hester
Review Article


Diabetic painful neuropathy (DPN) is one of the most common causes of neuropathic pain. The management of DPN consists of excluding other causes of painful peripheral neuropathy, maximising diabetic control and using medications to alleviate pain.

The precise relationship between glycaemic control and the development and severity of DPN remains controversial. In this context, drugs such as aldose reductase inhibitors, ACE inhibitors, lipid-lowering agents and α-lipoic acid (thioctic acid) may have a useful role to play. There is also evidence that a successful pancreatic transplant may improve symptoms over time, but the mainstay of management continues to be symptomatic control of pain with drugs.

Evidence from placebo-controlled studies has shown that opioids, antiepileptic and antidepressant drugs together with capsaicin are effective for alleviating DPN. Tramadol and oxycodone have been shown to be effective in studies of limited duration but their adverse effects, such as constipation and physical dependency, may limit their usefulness as a first-line treatment for DPN. Of the antidepressant drugs, the tricyclic antidepressants have been shown to be effective for alleviating DPN. These medications are widely used but their anticholinergic and sedative properties may not be well tolerated by patients. There is also good evidence that the serotonin-noradrenaline reuptake inhibitor antidepressant drugs venlafaxine and duloxetine are effective for treating DPN. However, venlafaxine may cause cardiac dysrhythmias, and patients using this medication require careful cardiac monitoring. Duloxetine appears to be less cardiotoxic and is licensed in the US and EU for alleviating DPN. The gabapentinoid group of drugs, gabapentin and pregabalin, appear to be the most evidence-based of the antiepileptic drugs for treating DPN. Large placebo-controlled studies have been performed with both of these agents. For many patients, it is still unclear what advantages pregabalin has over gabapentin for DPN. Until better evidence emerges, the potential availability of less expensive generic formulations of gabapentin, together with greater experience with its use, favour gabapentin as the main antiepileptic drug for alleviating DPN. Topiramate, lamotrigine, sodium valproate and oxcarbazepine have been shown to be effective in smaller studies but do not have the same evidence base as the gabapentinoid group of drugs. Of the newer antiepileptic drugs, lacosamide appears to be the most promising for alleviating DPN. Capsaicin has the best evidence base of all the topical agents, but local anaesthetic patches may also have a useful therapeutic role.

It is not possible to nominate a single drug as the first-line treatment for DPN and there is evidence that a low-dose combination of two or more drugs rather than a single agent may provide better symptomatic relief with fewer adverse effects. Further studies are necessary to clarify the best combination(s) of treatment for DPN.


Neuropathic Pain Capsaicin Gabapentin Lamotrigine Tramadol 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



No sources of funding were used to assist in the preparation of this review.

Dr Chong has received honoraria from Pfizer, Janssen-Cilag, Merck and Napp. Dr Hester has acted as a consultant to Wyeth and GlaxoSmithKline, and has received honoraria and/or grants from Pfizer, Napp and Janssen-Cilag.

The authors would like to thank Ms Tracey Steadman for secretarial help in preparing this manuscript.


  1. 1.
    Bora UT, Alp R, Sargin H, et al. Prevalence of peripheral neuropathy in type 2 diabetic patients attending a diabetes center in Turkey. Endocr J 2004 Dec; 51(6): 563–7CrossRefGoogle Scholar
  2. 2.
    Daousi C, MacFarlane IA, Woodward A, et al. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med 2004 Sep; 21(9): 976–82PubMedCrossRefGoogle Scholar
  3. 3.
    Novella SP, Inzucchi SE, Goldstein JM. The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve 2001 Sep; 24(9): 1229–31PubMedCrossRefGoogle Scholar
  4. 4.
    Singleton JR, Smith AG, Bromberg MB. Painful sensory polyneuropathy associated with impaired glucose tolerance. Muscle Nerve 2001 Sep; 24(9): 1225–8PubMedCrossRefGoogle Scholar
  5. 5.
    Gooch C, Podwall D. The diabetic neuropathies. Neurologist 2004 Nov; 10(6): 311–22PubMedCrossRefGoogle Scholar
  6. 6.
    Merskey H, Bogduk N, editors. IASP: task force on taxonomy. Classification of chronic pain. 2nd ed. Seattle (WA): IASP Press, 1994Google Scholar
  7. 7.
    Cruccu G, Anand P, Attal N, et al. EFNS guidelines on neuropathic pain assessment. Eur J Neurol 2004 Mar; 11(3): 153–62PubMedCrossRefGoogle Scholar
  8. 8.
    Bennett M. The LANSS Pain Scale: the Leeds Assessment of Neuropathic Symptoms and Signs. Pain 2001 May; 92(1–2): 147–57PubMedCrossRefGoogle Scholar
  9. 9.
    Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology 1997 Feb; 48(2): 332–8PubMedCrossRefGoogle Scholar
  10. 10.
    Shy ME, Frohman EM, So YT, et al. Quantitative sensory testing: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2003 Mar 25; 60(6): 898–904PubMedCrossRefGoogle Scholar
  11. 11.
    Polydefkis M, Hauer P, Griffin JW, et al. Skin biopsy as a tool to assess distal small fiber innervation in diabetic neuropathy. Diabetes Technol Ther 2001 Spring; 3(1): 23–8PubMedCrossRefGoogle Scholar
  12. 12.
    Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia 1996 Nov; 39(11): 1377–84PubMedCrossRefGoogle Scholar
  13. 13.
    Sorensen L, Molyneaux L, Yue DK. Insensate versus painful diabetic neuropathy: the effects of height, gender, ethnicity and glycaemic control. Diabetes Res Clin Pract 2002 Jul; 57(1): 45–51PubMedCrossRefGoogle Scholar
  14. 14.
    Herman WH, Aubert RE, Engelgau MM, et al. Diabetes mellitus in Egypt: glycaemic control and microvascular and neuropathic complications. Diabet Med 1998 Dec; 15(12): 1045–51PubMedCrossRefGoogle Scholar
  15. 15.
    Oyibo SO, Prasad YD, Jackson NJ, et al. The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study. Diabet Med 2002 Oct; 19(10): 870–3PubMedCrossRefGoogle Scholar
  16. 16.
    Oates PJ. Polyol pathway and diabetic peripheral neuropathy. Int Rev Neurobiol 2002; 50: 325–92PubMedCrossRefGoogle Scholar
  17. 17.
    Hotta N, Toyota T, Matsuoka K, et al. Clinical efficacy of fidarestat, a novel aldose reductase inhibitor, for diabetic peripheral neuropathy: a 52-week multicenter placebo-controlled double-blind parallel group study. Diabetes Care 2001 Oct; 24(10): 1776–82PubMedCrossRefGoogle Scholar
  18. 18.
    Hotta N, Sakamoto N, Shigeta Y, et al. Clinical investigation of epalrestat, an aldose reductase inhibitor, on diabetic neuropathy in Japan: multicenter study. Diabetic Neuropathy Study Group in Japan. J Diabetes Complications 1996 May–Jun; 10(3): 168–72Google Scholar
  19. 19.
    Hotta N, Akanuma Y, Kawamori R, et al. Long-term clinical effects of epalrestat, an aldose reductase inhibitor, on diabetic peripheral neuropathy: the 3-year, multicenter, comparative Aldose Reductase Inhibitor-Diabetes Complications Trial. Diabetes Care 2006 Jul; 29(7): 1538–44PubMedCrossRefGoogle Scholar
  20. 20.
    Malik RA, Williamson S, Abbott C, et al. Effect of angiotensin-converting-enzyme (ACE) inhibitor trandolapril on human diabetic neuropathy: randomised double-blind controlled trial. Lancet 1998 Dec 19–26; 352(9145): 1978–81PubMedCrossRefGoogle Scholar
  21. 21.
    Fried LF, Forrest KY, Ellis D, et al. Lipid modulation in insulin-dependent diabetes mellitus: effect on microvascular outcomes. J Diabetes Complications 2001 May–Jun; 15(3): 113–9PubMedCrossRefGoogle Scholar
  22. 22.
    Leiter LA. The prevention of diabetic microvascular complications of diabetes: is there a role for lipid lowering? Diabetes Res Clin Pract 2005 Jun; 68 Suppl. 2: S3–14PubMedCrossRefGoogle Scholar
  23. 23.
    Ziegler D, Nowak H, Kempler P, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a meta-analysis. Diabet Med 2004 Feb; 21(2): 114–21PubMedCrossRefGoogle Scholar
  24. 24.
    Ziegler D, Hanefeld M, Ruhnau KJ, et al. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid: a 7-month multicenter randomized controlled trial (ALADIN III Study). ALADIN III Study Group: Alpha-Lipoic Acid in Diabetic Neuropathy. Diabetes Care 1999 Aug; 22(8): 1296–301Google Scholar
  25. 25.
    Ziegler D, Ametov A, Barinov A, et al. Oral treatment with alpha-lipoic acid improves symptomatic diabetic polyneuropathy: the SYDNEY 2 trial. Diabetes Care 2006 Nov; 29(11): 2365–70PubMedCrossRefGoogle Scholar
  26. 26.
    Agudo R, Valls-Sole J, Recasens M, et al. Effects of kidney and pancreas transplantation on neurophysiological rates of polyneuropathy and autonomous cardiac function in diabetic patients with end-stage renal disease [in Spanish]. Med Clin (Barc) 2002 Apr 20; 118(14): 534–8Google Scholar
  27. 27.
    Norden G, Olausson M, Andersen O. A case of painful progressive peripheral neuropathy after successful pancreas transplantation. J Diabet Complications 1991 Oct–Dec; 5(4): 249–51PubMedCrossRefGoogle Scholar
  28. 28.
    Forst T, Nguyen M, Forst S, et al. Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. Diabetes Nutr Metab 2004 Jun; 17(3): 163–8PubMedGoogle Scholar
  29. 29.
    Kumar D, Marshall HJ. Diabetic peripheral neuropathy: amelioration of pain with transcutaneous electrostimulation. Diabetes Care 1997 Nov; 20(11): 1702–5PubMedCrossRefGoogle Scholar
  30. 30.
    Daousi C, Benbow SJ, MacFarlane IA. Electrical spinal cord stimulation in the long-term treatment of chronic painful diabetic neuropathy. Diabet Med 2005 Apr; 22(4): 393–8PubMedCrossRefGoogle Scholar
  31. 31.
    Khedr EM, Kotb H, Kamel NF, et al. Longlasting antalgic effects of daily sessions of repetitive transcranial magnetic stimulation in central and peripheral neuropathic pain. J Neurol Neurosurg Psychiatry 2005 Jun; 76(6): 833–8PubMedCrossRefGoogle Scholar
  32. 32.
    Cohen KL, Harris S. Efficacy and safety of nonsteroidal anti-inflammatory drugs in the therapy of diabetic neuropathy. Arch Intern Med 1987 Aug; 147(8): 1442–4PubMedCrossRefGoogle Scholar
  33. 33.
    Harati Y, Gooch C, Swenson M, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology 1998 Jun; 50(6): 1842–6PubMedCrossRefGoogle Scholar
  34. 34.
    Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology 2003 Mar 25; 60(6): 927–34PubMedCrossRefGoogle Scholar
  35. 35.
    Rowbotham MC, Goli V, Kunz NR, et al. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. Pain 2004 Aug; 110(3): 697–706PubMedCrossRefGoogle Scholar
  36. 36.
    Goldstein DJ, Lu Y, Detke MJ, et al. Duloxetine vs placebo in patients with painful diabetic neuropathy. Pain 2005 Jul; 116(1–2): 109–18PubMedCrossRefGoogle Scholar
  37. 37.
    Raskin J, Pritchett YL, Wang F, et al. A double-blind, randomized multicenter trial comparing duloxetine with placebo in the management of diabetic peripheral neuropathic pain. Pain Med 2005 Sep–Oct; 6(5): 346–56PubMedCrossRefGoogle Scholar
  38. 38.
    Wernicke JF, Pritchett YL, D’Souza DN, et al. A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology 2006 Oct; 67(8): 1411–20PubMedCrossRefGoogle Scholar
  39. 39.
    Backonja M, Beydoun A, Edwards KR, et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA 1998 Dec 2; 280(21): 1831–6PubMedCrossRefGoogle Scholar
  40. 40.
    Kochar DK, Jain N, Agarwal RP, et al. Sodium valproate in the management of painful neuropathy in type 2 diabetes: a randomized placebo controlled study. Acta Neurol Scand 2002; 106: 248–52PubMedCrossRefGoogle Scholar
  41. 41.
    Eisenberg E, Lurie Y, Braker C, et al. Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology 2001 Aug 14; 57(3): 505–9PubMedCrossRefGoogle Scholar
  42. 42.
    Dogra S, Beydoun S, Mazzola J, et al. Oxcarbazepine in painful diabetic neuropathy: a randomized, placebo-controlled study. Eur J Pain 2005 Oct; 9(5): 543–54PubMedCrossRefGoogle Scholar
  43. 43.
    Beydoun A, Shaibani A, Hopwood M, et al. Oxcarbazepine in painful diabetic neuropathy: results of a dose-ranging study. Acta Neurol Scand 2006 Jun; 113(6): 395–404PubMedCrossRefGoogle Scholar
  44. 44.
    Raskin P, Donofrio PD, Rosenthal NR, et al. Topiramate vs placebo in painful diabetic neuropathy: analgesic and metabolic effects. Neurology 2004 Sep 14; 63(5): 865–73PubMedCrossRefGoogle Scholar
  45. 45.
    Rosenstock J, Tuchman M, LaMoreaux L, et al. Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain 2004 Aug; 110(3): 628–38PubMedCrossRefGoogle Scholar
  46. 46.
    Lesser H, Sharma U, LaMoreaux L, et al. Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology 2004 Dec 14; 63(11): 2104–10PubMedCrossRefGoogle Scholar
  47. 47.
    Richter RW, Portenoy R, Sharma U, et al. Relief of painful diabetic peripheral neuropathy with pregabalin: a randomized, placebo-controlled trial. J Pain 2005 Apr; 6(4): 253–60PubMedCrossRefGoogle Scholar
  48. 48.
    Freynhagen R, Strojek K, Griesing T, et al. Efficacy of pregabalin in neuropathic pain evaluated in a 12-week, randomised, double-blind, multicentre, placebo-controlled trial of flexible- and fixed-dose regimens. Pain 2005 Jun; 115(3): 254–63PubMedCrossRefGoogle Scholar
  49. 49.
    The Capsaicin Study Group. Treatment of painful diabetic neuropathy with topical capsaicin: a multicenter, double-blind, vehicle-controlled study. Arch Intern Med 1991 Nov; 151(11): 2225–9CrossRefGoogle Scholar
  50. 50.
    Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ 1995 Feb 18; 310(6977): 452–4PubMedCrossRefGoogle Scholar
  51. 51.
    McQuay HJ, Moore RA. Using numerical results from systematic reviews in clinical practice. Ann Intern Med 1997 May 1; 126(9): 712–20PubMedGoogle Scholar
  52. 52.
    Moore RA, Gavaghan D, Tramer MR, et al. Size is everything: large amounts of information are needed to overcome random effects in estimating direction and magnitude of treatment effects. Pain 1998 Dec; 78(3): 209–16PubMedCrossRefGoogle Scholar
  53. 53.
    Farrar JT, Young JP Jr, LaMoreaux L, et al. Clinical importance of changes in chronic pain intensity measured on an 11 -point numerical pain rating scale. Pain 2001 Nov; 94(2): 149–58PubMedCrossRefGoogle Scholar
  54. 54.
    Gourlay GK. Advances in opioid pharmacology. Support Care Cancer 2005 Mar; 13(3): 153–9PubMedCrossRefGoogle Scholar
  55. 55.
    Watson CP, Moulin D, Watt-Watson J, et al. Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain 2003 Sep; 105(1–2): 71–8PubMedCrossRefGoogle Scholar
  56. 56.
    British Pain Society [online]. Available from URL: [Accessed 2006 Dec 14]
  57. 57.
    Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain: an update and effect related to mechanism of drug action. Pain 1999 Dec; 83(3): 389–400PubMedCrossRefGoogle Scholar
  58. 58.
    Max MB, Lynch SA, Muir J, et al. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med 1992 May 7; 326(19): 1250–6PubMedCrossRefGoogle Scholar
  59. 59.
    Kvinesdal B, Molin J, Froland A, et al. Imipramine treatment of painful diabetic neuropathy. JAMA 1984 Apr 6; 251(13): 1727–30PubMedCrossRefGoogle Scholar
  60. 60.
    Sindrup SH, Ejlertsen B, Froland A, et al. Imipramine treatment in diabetic neuropathy: relief of subjective symptoms without changes in peripheral and autonomic nerve function. Eur J Clin Pharmacol 1989; 37(2): 151–3PubMedCrossRefGoogle Scholar
  61. 61.
    Sindrup SH, Gram LF, Skjold T, et al. Concentration-response relationship in imipramine treatment of diabetic neuropathy symptoms. Clin Pharmacol Ther 1990 Apr; 47(4): 509–15PubMedCrossRefGoogle Scholar
  62. 62.
    Sindrup SH, Gram LF, Skjold T, et al. Clomipramine vs desipramine vs placebo in the treatment of diabetic neuropathy symptoms: a double-blind cross-over study. Br J Clin Pharmacol 1990 Nov; 30(5): 683–91PubMedCrossRefGoogle Scholar
  63. 63.
    Max MB, Kishore-Kumar R, Schafer SC, et al. Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial. Pain 1991 Apr; 45(1): 3–9PubMedCrossRefGoogle Scholar
  64. 64.
    Sindrup SH, Gram LF, Brosen K, et al. The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. Pain 1990 Aug; 42(2): 135–44PubMedCrossRefGoogle Scholar
  65. 65.
    Sindrup SH, Bjerre U, Dejgaard A, et al. The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy. Clin Pharmacol Ther 1992 Nov; 52(5): 547–52PubMedCrossRefGoogle Scholar
  66. 66.
    Chadda VS, Mathur MS. Double blind study of the effects of diphenylhydantoin sodium on diabetic neuropathy. J Assoc Physicians India 1978 May; 26(5): 403–6PubMedGoogle Scholar
  67. 67.
    Saudek CD, Wems S, Reidenberg MM. Phenytoin in the treatment of diabetic symmetrical polyneuropathy. Clin Pharmacol Ther 1977 Aug; 22(2): 196–9PubMedGoogle Scholar
  68. 68.
    Rull JA, Quibrera R, Gonzalez-Millan H, et al. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double blind crossover trial. Diabetologia 1969 Aug; 5(4): 215–8PubMedCrossRefGoogle Scholar
  69. 69.
    Mellegers MA, Furlan AD, Mallis A. Gabapentin for neuropathic pain: systematic review of controlled and uncontrolled literature. Clin J Pain 2001 Dec; 17(4): 284–95PubMedCrossRefGoogle Scholar
  70. 70.
    Sindrup SH, Otto M, Bach FW, et al. Sodium valproate in painful diabetic polyneuropathy. Acta Neurol Scand 2003 Dec; 108(6): 443–4PubMedCrossRefGoogle Scholar
  71. 71.
    Vinik AI, Tuchman M, Safirstein B, et al. Lamotrigine for treatment of pain associated with diabetic neuropathy: results of two randomized, double-blind, placebo-controlled studies. Pain. Epub 2006 Dec 8Google Scholar
  72. 72.
    Thienel U, Neto W, Schwabe SK, et al. Topiramate in painful diabetic polyneuropathy: findings from three double-blind placebo-controlled trials. Acta Neurol Scand 2004 Oct; 110(4): 221–31PubMedCrossRefGoogle Scholar
  73. 73.
    Donofrio PD, Raskin P, Rosenthal NR, et al. Safety and effectiveness of topiramate for the management of painful diabetic peripheral neuropathy in an open-label extension study. Clin Ther 2005 Sep; 27(9): 1420–31PubMedCrossRefGoogle Scholar
  74. 74.
    Oaklander AL, Buchbinder BR. Pregabalin-withdrawal encephalopathy and splenial edema: a link to high-altitude illness? Ann Neurol 2005 Aug; 58(2): 309–12PubMedCrossRefGoogle Scholar
  75. 75.
    Atli A, Dogra S. Zonisamide in the treatment of painful diabetic neuropathy: a randomized, double-blind, placebo-controlled pilot study. Pain Med 2005 May–Jun; 6(3): 225–34PubMedCrossRefGoogle Scholar
  76. 76.
    Ertas M, Sagduyu A, Arac N, et al. Use of levodopa to relieve pain from painful symmetrical diabetic polyneuropathy. Pain 1998 Apr; 75(2–3): 257–9PubMedCrossRefGoogle Scholar
  77. 77.
    Yuen KC, Baker NR, Rayman G. Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray: a double-blind placebo-controlled cross-over study. Diabetes Care 2002 Oct; 25(10): 1699–703PubMedCrossRefGoogle Scholar
  78. 78.
    Devers A, Galer BS. Topical lidocaine patch relieves a variety of neuropathic pain conditions: an open-label study. Clin J Pain 2000 Sep; 16(3): 205–8PubMedCrossRefGoogle Scholar
  79. 79.
    Barbano RL, Herrmann DN, Hart-Gouleau S, et al. Effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in diabetic polyneuropathy. Arch Neurol 2004 Jun; 61(6): 914–8PubMedCrossRefGoogle Scholar
  80. 80.
    Biesbroeck R, Bril V, Hollander P, et al. A double-blind comparison of topical capsaicin and oral amitriptyline in painful diabetic neuropathy. Adv Ther 1995 Mar–Apr; 12(2): 111–20PubMedGoogle Scholar
  81. 81.
    Nelson KA, Park KM, Robinovitz E, et al. High-dose oral dextromethorphan versus placebo in painful diabetic neuropathy and postherpetic neuralgia. Neurology 1997 May; 48(5): 1212–8PubMedCrossRefGoogle Scholar
  82. 82.
    Pellegrino RG, Petit WA, Brazg R, et al. Memantine in the treatment of diabetic peripheral neuropathy: a placebo-controlled phase II trial [abstract no. S15.004]. Neurology 2000; 54 (7 Suppl. 3): A82Google Scholar
  83. 83.
    Sang CN, Booher S, Gilron I, et al. Dextromethorphan and memantine in painful diabetic neuropathy and postherpetic neuralgia: efficacy and dose-response trials. Anesthesiology 2002 May; 96(5): 1053–61PubMedCrossRefGoogle Scholar
  84. 84.
    Schwarz Pharma. Positive data from phase III program for lacosamide [online]. Available from URL: [Accessed 2006 Dec 14]
  85. 85. Randomised control trial studying the addition of CBME to conventional treatment for the relief of painful diabetic neuropathy [online]. Available from URL: [Accessed 2006 Dec 14]
  86. 86.
    TimesOnline. Cannabis experiment helps kill OAP, says coroner [online]. Available from URL:,2-1936405,00.html [Accessed 2006 Dec 14]
  87. 87.
    Finnerup NB, Otto M, McQuay HJ, et al. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain 2005 Dec 5; 118(3): 289–305PubMedCrossRefGoogle Scholar
  88. 88.
    Morello CM, Leckband SG, Stoner CP, et al. Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Arch Intern Med 1999 Sep 13; 159(16): 1931–7PubMedCrossRefGoogle Scholar
  89. 89.
    Dallocchio C, Buffa C, Mazzarello P, et al. Gabapentin vs amitriptyline in painful diabetic neuropathy: an open-label pilot study. J Pain Symptom Manage 2000 Oct; 20(4): 280–5PubMedCrossRefGoogle Scholar
  90. 90.
    Rasmussen PV, Sindrup SH, Jensen TS, et al. Therapeutic outcome in neuropathic pain: relationship to evidence of nervous system lesion. Eur J Neurol 2004 Aug; 11(8): 545–53PubMedCrossRefGoogle Scholar
  91. 91.
    Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med 2005 Mar 31; 352(13): 1324–34PubMedCrossRefGoogle Scholar

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© Adis Data Information BV 2007

Authors and Affiliations

  1. 1.Department of NeurologyThe Medway Hospital NHS TrustGillingham, KentUK
  2. 2.Department of Neurology, Pain Management UnitKings College Hospital NHS Trust, Ruskin WingLondonUK

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