Managing Diabetic Peripheral Neuropathic Pain: What's Most Effective?
|The following article features coverage from PAINWeek 2017 in Las Vegas, Nevada. Click here to read more of MPR's conference coverage.|
LAS VEGAS — In a presentation at PAINWeek 2017, held September 5-9 in Las Vegas, Nevada, Ramon L. Cuevas-Trisan, MD, chief of the physical medicine, rehabilitation & pain management service at West Palm Beach VA Medical Center in Florida, covered the evaluation and management of diabetic peripheral neuropathic (DPN) pain.1
Painful diabetic neuropathy is estimated to affect one-quarter of patients with diabetes, and rates are increasing along with the prevalence of diabetes in the United States — currently approaching 10% of the population, with a 5% annual growth.2,3 Adequate evaluation and diagnosis of DPN pain are essential. “There are no direct diagnosing methods, only indirect examination methods, together with the patient's complaints,” Dr Cuevas-Trisan told MPR. Diagnosis is based on the patient's history of neuropathic pain, combined with findings on examination that indicate deficits associated with neuropathy, such as decreased or altered sensation, atrophy, and intermittent or continuous pain with a distal-to-proximal (“stocking-and-glove”) distribution that is often symmetrical and may worsen at night.
DPN pain is difficult to treat, and not all patients respond to treatment. Optimization of glycemic control is widely accepted as the first step in managing DPN pain (although the related evidence is unclear and even contradictory), followed by pharmacological approaches. During his presentation, Dr Cuevas-Trisan noted that components of metabolic syndrome may also “be potential risk factors since these CV risk factors cluster with hyperglycemia.” For example, higher rates of neuropathy, higher pain scores, and lower quality of life have been observed in individuals with vs individuals without obesity, even in the absence of prediabetes or diabetes.4
For pharmacological treatment of painful diabetic neuropathy, the most robust evidence exists for tricyclic antidepressants, pregabalin, duloxetine, and venlafaxine.
Dr Cuevas-Trisan is a member of Allergan's speakers' bureau.
Read more of MPR's coverage of PAINWeek 2017 by visiting the conference page.
- Cuevas-Trisan R. Diabetic peripheral neuropathic pain: evaluating treatment options. Presented at Pain Week 2017; September 5-9, 2017; Las Vegas, Nevada.
- Kaur S, Pandhi P, Dutta P. Painful diabetic neuropathy: an update. Ann Neurosci. 2011; 18(4):168-175. doi:10.5214/ans.0972-7531.1118409
- Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. Juster-Switlyk K, Smith AG. Updates in diabetic peripheral neuropathy. F1000Research. 2016; 5:F1000 Faculty Rev-738. doi:10.12688/f1000research.7898.1
- Callaghan BC, Xia R, Reynolds E, et al. Association between metabolic syndrome components and polyneuropathy in an obese population. JAMA Neurol. 2016; 73(12):1468-1476. doi:10.1001/jamaneurol.2016.3745
- Finnerup NB, Otto M, McQuay HJ, Jensen TS, Sindrup SH. Algorithm for neuropathic pain treatment: an evidence based proposal. Pain. 2005; 118(3):289-305. doi:10.1016/j.pain.2005.08.013
- Bril V, England J, Franklin GM, et al. Evidence-based guideline: Treatment of painful diabetic neuropathy. Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2011; 76(20):1758-1765. doi:10.1212/WNL.0b013e3182166ebe
- Waldfogel JM, Nesbit SA, Dy SM, et al. Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review. Neurology. 2017; 88(20):1958-1967. doi:10.1212/WNL.0000000000003882