Skip to main content

Management of Neuropathic Pain

  • Chapter
  • First Online:
Painful Diabetic Neuropathy in Clinical Practice

Abstract

Neuropathic pain affects many areas of the patient’s life, so a multidisciplinary approach is essential in managing the ­condition. In many cases the clinical assessment will indicate the need for psychological or physical therapy in addition to standard pharmacological treatments. Similarly, support and information on practical measures – such as using a bed cradle to lift bedclothes off hyperaesthetic skin – often prove invaluable.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. DCCT Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122:561-568.

    Google Scholar 

  2. Partanen J, Niskanen L, Lehtinen J, et al. Natural history of peripheral neuropathy in patients with non-insulin dependent diabetes. N Engl J Med. 1995;333:89-94.

    Article  PubMed  CAS  Google Scholar 

  3. Tesfaye S, Stevens LK, Stephenson JM, et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risks: the EuroDiab ID M complication study. Diabetologia. 1996;39:1377-1386.

    Article  PubMed  CAS  Google Scholar 

  4. Oyibo S, Prasad YD, Jackson NJ, et al. The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study. Diabet Med. 2002;19:870-873.

    Article  PubMed  CAS  Google Scholar 

  5. Kihara M, Zollman PJ, Smithson IL, et al. Hypoxic effect of exogenous insulin on normal and diabetic peripheral nerve. Am J Physiol. 1994;226(6Pt 1):E980-E985.

    Google Scholar 

  6. Kennedy WR, Navarro X, Goetz FC, et al. Effects of pancreas ­transplantation on diabetic neuropathy. N Engl J Med. 1990;322:1031-1037.

    Article  PubMed  CAS  Google Scholar 

  7. Mehra S, Tavakoli M, Kallinikos PA, et al. Corneal confocal microscopy detects early nerve regeneration after pancreas transplantation in patients with type 1 diabetes. Diab Care. 2007;30:2608-2612.

    Article  Google Scholar 

  8. Boulton AJM, Drury J, Clarke B, et al. Continuous subcutaneous insulin infusion in the management of painful diabetic neuropathy. Diab Care. 1982;5:386-390.

    Article  CAS  Google Scholar 

  9. McQuay H, Tramer M, Nye BA. A systemic review of antidepressants in neuropathic pain. Pain. 1996;68:217-227.

    Article  PubMed  CAS  Google Scholar 

  10. Max MB. Antidepressants as analgesics. In: Fields HL, Liebeskind JC, eds. Pharmacological approaches to the treatment of chronic pain: new concepts and critical issues. Progress in Pain Research and Management (Vol 1). Seattle: IASP; 1994:229-246.

    Google Scholar 

  11. Max MB, Lynch SA, Muir J, et al. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med. 1992;326:1250-1256.

    Article  PubMed  CAS  Google Scholar 

  12. Watson CP. The treatment of neuropathic pain: antidepressants and opioids. Clin J Pain. 2000;16(2 suppl):S49-S55.

    PubMed  CAS  Google Scholar 

  13. Mendell JR, Sahenk Z. Painful sensory neuropathy. N Engl J Med. 2003;348:1243-1255.

    Article  PubMed  Google Scholar 

  14. Boulton AJM, Malik RA, Arezzo JS, et al. Diabetic somatic neuropathies. Diab Care. 2004;27:1458-1486.

    Article  Google Scholar 

  15. Sindrup SH, Gram LF, Brosen K, et al. The SSRI paroxetine is effective in the treatment of diabetic neuropathy symptoms. Pain. 1990;42:135-144.

    Article  PubMed  CAS  Google Scholar 

  16. Sindrup SH, Bjerre U, Dejgaard A, et al. The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy. Clin Pharmacol Ther. 1992;52:547-552.

    Article  PubMed  CAS  Google Scholar 

  17. Goldstein DJ, Lu Y, Detke MJ, et al. Duloxetine vs placebo in patients with diabetic neuropathy. Pain. 2005;116:109-118.

    Article  PubMed  CAS  Google Scholar 

  18. Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicenter, randomized, double-blind, placebo-controlled, parallel-group studies. Clin Ther. 2007;29(suppl 2):536-546.

    Google Scholar 

  19. Basile AS, Janowsky A, Golembiowska K, et al. Characterization of the antinociceptive actions of bicifadine in models of acute, persistent, and chronic pain. J Pharmacol Exp Ther. 2007;321:1208-1225.

    Article  PubMed  CAS  Google Scholar 

  20. Rull JA, Quibrera R, Gonzalez-Millan H, et al. Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine (Tegretol): double-blind crossover trial. Diabetologia. 1969;5:215-218.

    Article  PubMed  CAS  Google Scholar 

  21. Saudek CD, Werns S, Reidenberg MM. Phenytoin in the treatment of diabetic symmetrical polyneuropathy. Clin Pharmacol Ther. 1977;22:196-199.

    PubMed  CAS  Google Scholar 

  22. 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;106:248-252.

    Article  PubMed  CAS  Google Scholar 

  23. Vinik AI. Use of antiepileptic drugs in the treatment of chronic ­painful diabetic neuropathy. J Clin Endocrinol Metab. 2005;90:4936-4945.

    Article  PubMed  CAS  Google Scholar 

  24. Backonja MM, Beydoun A, Edwards KR, et al. Gabapentin for symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA. 1998;280:1831-1836.

    Article  PubMed  CAS  Google Scholar 

  25. Rowbotham M, Harden N, Stacey B, et al. The gabapentin study group. Gabapentin for the treatment of postherpetic neuralgia. JAMA. 1998;280:1837-1843.

    Article  PubMed  CAS  Google Scholar 

  26. Backonja M, Glazman RI. Gabapentin dosing for neuropathic pain evidence from randomized placebo controlled clinical trials. Clin Ther. 2003;25:81-104.

    Article  PubMed  CAS  Google Scholar 

  27. DIN-LINK data, Cegedim Strategic Data, October 2006. Data calculated based on prescriptions where dosing instructions are known.

    Google Scholar 

  28. Rosenstock J, Tuchman M, LaMoreau L, et al. Pregabalin for the treatment of painful diabetic neuropathy: a randomized, controlled trial. Pain. 2004;110:628-634.

    Article  PubMed  CAS  Google Scholar 

  29. Richter RW, Portenoy R, Sharma M, et al. Relief of painful diabetic neuropathy with pregabalin: a randomized, placebo-controlled trial. J Pain. 2005;6:253-260.

    Article  PubMed  CAS  Google Scholar 

  30. Lesser H, Sharma U, LaMoreaux L, et al. Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. Neurology. 2004;63:2104-2110.

    PubMed  CAS  Google Scholar 

  31. Serpell M. Recognising and treating neuropathic pain. Available at: www.progressnp.com. Last accessed August 2007.

  32. Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diab Care. 2008;31:1448-1454.

    Article  CAS  Google Scholar 

  33. Beydoun A, Kobetz SA, Carrazana EJ. Efficacy of oxcarbazepine in the treatment of diabetic neuropathy. Clin J Pain. 2004;20:174-178.

    Article  PubMed  Google Scholar 

  34. Kochar DK, Rawat N, Agrawal RP, et al. Sodium valproate for painful diabetic neuropathy: a randomized double-blind trial. Q J Med. 2004;97:33-38.

    CAS  Google Scholar 

  35. Eisenberg E, Lurie Y, Braker C, et al. Lamotrigine reduces painful diabetic neuropathy. Neurology. 2001;57:505-509.

    PubMed  CAS  Google Scholar 

  36. Edwards K, Glantz MJ, Button J, et al. Efficacy and safety of topiramate in the treatment of painful diabetic neuropathy: a double-blind placebo-controlled study. Neurology. 2000;54(suppl 3):A81.

    Google Scholar 

  37. Rauck RL, Shaibani A, Biton V, et al. Lacosamide in painful diabetic peripheral neuropathy: a phase 2 double-blind placebo-controlled study. Clin J Pain. 2007;23:150-158.

    Article  PubMed  Google Scholar 

  38. Ziegler D. Painful diabetic neuropathy: treatment and future aspects. Diabetes Metab Res Rev. 2008;24(suppl 1):S52-S57.

    Article  PubMed  Google Scholar 

  39. Kastrup J, Petersen P, Dejard A, et al. Intravenous lidocaine infusion: a new treatment of chronic painful diabetic neuropathy. Pain. 1987;28:69-75.

    Article  PubMed  CAS  Google Scholar 

  40. Dejgard A, Peterson P, Kastrup J. Mexiletine for treatment of chronic painful diabetic neuropathy. Lancet. 1988;1:9-11.

    Article  PubMed  CAS  Google Scholar 

  41. Oskarsson P, Lins PE, Ljunggren JG, et al. Efficacy and safety of mexiletine in the treatment of painful diabetic neuropathy. Diab Care. 1997;20:1594-1597.

    Article  CAS  Google Scholar 

  42. Jarvis B, Coukell AJ. Mexilitene: a review of its therapeutic use in painful diabetic neuropathy. Drugs. 1998;56:691-708.

    Article  PubMed  CAS  Google Scholar 

  43. Foley K. Opioids and chronic neuropathic pain. N Engl J Med. 2003;348:1279-1281.

    Article  PubMed  Google Scholar 

  44. 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;50:1842-1846.

    PubMed  CAS  Google Scholar 

  45. Harati Y, Gooch C, Swenson M, et al. Maintenance of the long-term effectiveness of tramadol in treatment of the pain of diabetic neuropathy. J Diabetes Complications. 2000;14:65-70.

    Article  PubMed  CAS  Google Scholar 

  46. Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomized controlled trial. Neurology. 2003;60:927-934.

    PubMed  CAS  Google Scholar 

  47. Watson CPN, Moulin D, Watt-Watson J, et al. Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain. 2003;105:71-78.

    Article  PubMed  CAS  Google Scholar 

  48. Bansal D, Bhansali A, Hota D, et al. Amitriptyline vs pregabalin in painful diabetic neuropathy: a randomised double-blind clinical trial. Diabet Med. 2009;26:1019-1026.

    Article  PubMed  CAS  Google Scholar 

  49. Gilron I, Bailey JM, Tu D, et al. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind randomised controlled crossover trial. Lancet. 2009;374:1252-1261.

    Article  PubMed  CAS  Google Scholar 

  50. Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin: a meta analysis. Eur J Clin Pharmacol. 1994;46:517-522.

    Article  PubMed  CAS  Google Scholar 

  51. Low PA, Opfer-Gehrking TL, Dyck PJ, et al. Double-blind placebo-controlled study of capsaicin cream in chronic distal painful polyneuropathy. Pain. 1995;62:163-168.

    Article  PubMed  CAS  Google Scholar 

  52. Barbano RL, Herrman 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;61:914-918.

    Article  PubMed  Google Scholar 

  53. Yuen KC, Baker NR, Rayman G. Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray: a double-blind placebo-controlled cross-over study. Diab Care. 2002;25:1699-1703.

    Article  CAS  Google Scholar 

  54. Rayman G, Baker NR, Krishnan ST. Glyceryl trinitrate patches as an alternative to isosorbide dinitrate spray in the treatment of painful neuropathy. Diab Care. 2003;26:2697-2698.

    Article  Google Scholar 

  55. Abuaisha BB, Constanzi JB, Boulton AJM. Acupuncture for the treatment of chronic painful diabetic neuropathy: a long-term study. Diabetes Res Clin Pract. 1998;39:115-121.

    Article  PubMed  CAS  Google Scholar 

  56. Oyibo S, Breislin K, Boulton AJM. Electrical stimulation therapy through stocking electrodes for painful diabetic neuropathy: a double-blind controlled crossover study. Diabet Med. 2004;21:940-944.

    Article  PubMed  CAS  Google Scholar 

  57. Zinman LH, Ngo M, Ng ET, et al. Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy: a controlled trial. Diab Care. 2004;27:921-924.

    Article  Google Scholar 

  58. Hamza MA, White PF, Craig WF, et al. Percutaneous electrical nerve stimulation: a novel analgesic therapy for diabetic neuropathic pain. Diab Care. 2000;23:365-370.

    Article  CAS  Google Scholar 

  59. Weintraub MI, Wolfe GI, Baronh RA, et al. Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized, double-blind, placebo controlled trial. Arch Phys Med Rehabil. 2003;84:736-746.

    Article  PubMed  Google Scholar 

  60. Leonard DR, Farooqu MH, Myers S. Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy: a double blind, randomized placebo-controlled study with monochromatic infrared treatment. Diab Care. 2004;27:168-172.

    Article  Google Scholar 

  61. Tesfaye S, Watt J, Benbow SJ, et al. Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy. Lancet. 1996;348:1698-1701.

    Article  PubMed  CAS  Google Scholar 

  62. Daousi C, Benbow SJ, Macfarlane IA. Electrical spinal cord stimulation in the long-term treatment of chronic painful diabetic neuropathy. Diabet Med. 2005;22:393-398.

    Article  PubMed  CAS  Google Scholar 

  63. Boulton AJ, Vinik AI, Arezzo JC, et al. Diabetic neuropathies: a statement by the American Diabetes Association. Diab Care. 2005;28:956-962.

    Article  Google Scholar 

  64. Freynhagen R, Bennett MI. Diagnosis and management of neuropathic pain. BMJ. 2009;339:B3002.

    Article  PubMed  CAS  Google Scholar 

  65. Moulin DE, Clark AJ, Gilron I, et al. Pharmacological management of chronic neuropathic pain – consenus statement and guidelines from the Canadian Pain Society. Pain Res Manag. 2007;12:13-21.

    PubMed  CAS  Google Scholar 

  66. Attal N, Cruccu G, Haanpaa M, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain. Eur J Neurol. 2006;13:1153-1169.

    Article  PubMed  CAS  Google Scholar 

  67. NICE Clinical Guideline 96: Neuropathic Pain. The pharmacological management of neuropathic pain in adults and in a non-specialist settings. Available at: www.nice.org.uk. Accessed March 2010.

  68. Boulton AJM. NICE guidelines of the management of painful diabetic neuropathy. Pract Diabetes Int. 2010;27:1-2.

    Article  Google Scholar 

  69. Tesfaye S, Boulton AJM, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity and treatments. Diab Care. 2010;33:2285-2293.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

Copyright information

© 2011 Springer-Verlag London Limited

About this chapter

Cite this chapter

Boulton, A.J.M., Vileikyte, L. (2011). Management of Neuropathic Pain. In: Painful Diabetic Neuropathy in Clinical Practice. Springer, London. https://doi.org/10.1007/978-0-85729-488-3_4

Download citation

  • DOI: https://doi.org/10.1007/978-0-85729-488-3_4

  • Published:

  • Publisher Name: Springer, London

  • Print ISBN: 978-0-85729-487-6

  • Online ISBN: 978-0-85729-488-3

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics