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Pharmacological Treatment of Diabetic Neuropathic Pain

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Abstract

Neuropathic pain continues to be a difficult and challenging clinical issue to deal with effectively. Painful diabetic polyneuropathy is a complex pain condition that occurs with reasonable frequency in the population and it may be extremely difficult for clinicians to provide patients with effective analgesia. Chronic neuropathic pain may occur in approximately one of every four diabetic patients. The pain may be described as burning or a deep-seated ache with sporadic paroxysms of lacinating painful exacerbations. The pain is often constant, moderate to severe in intensity, usually primarily involves the feet and generally tends to worsen at night. Treatment may be multimodal but largely involves pharmacological approaches. Pharmacological therapeutic options include antidepressants (tricyclic antidepressants, serotoninnorepinephrine reuptake inhibitors), α2δ ligands and topical (5%) lidocaine patch. Other agents may be different antiepileptic drugs (carbamazepine, lamotrigine, topiramate), topical capsaicin, tramadol and other opioids.

Progress continues with respect to understanding various mechanisms that may contribute to painful diabetic neuropathy. Agents that may hold some promise include neurotrophic factors, growth factors, immunomdoulators, gene therapy and poly (adenosine diphosphate-ribose) polymerase inhibitors. It is hoped that in the future clinicians will be able to assess patient pathophysiology, which may help them to match optimal therapeutic agents to target individual patient aberrant mechanisms.

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Acknowledgements

There was no funding or help from any sources for anything related to the submission of this paper.

The authors have no relevant conflicts of interest that affected the content of manuscript. Disclosures: Pfizer and Lilly: advisory board/speakers bureau; Endo: grant received; Lilly: grant received; Pfizer: grant pending.

The authors would like to acknowledge Pya Seidner for her help in the preparation of this manuscript.

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  1. Department of Anesthesiology, Albany Medical College, 47 New Scotland Avenue, MC-131, Albany, New York, 12208, USA

    Howard S. Smith (Professor & Academic Director of Pain Management)

  2. Comprehensive Pain Center, Albany Medical College, Albany, New York, USA

    Charles E. Argoff

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Smith, H.S., Argoff, C.E. Pharmacological Treatment of Diabetic Neuropathic Pain. Drugs 71, 557–589 (2011). https://doi.org/10.2165/11588940-000000000-00000

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