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Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review

Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest cha...

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Autores principales: Ardeleanu, Valeriu, Toma, Alexandra, Pafili, Kalliopi, Papanas, Nikolaos, Motofei, Ion, Diaconu, Camelia Cristina, Rizzo, Manfredi, Pantea Stoian, Anca
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022869/
https://www.ncbi.nlm.nih.gov/pubmed/31936646
http://dx.doi.org/10.3390/medicina56010025
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author Ardeleanu, Valeriu
Toma, Alexandra
Pafili, Kalliopi
Papanas, Nikolaos
Motofei, Ion
Diaconu, Camelia Cristina
Rizzo, Manfredi
Pantea Stoian, Anca
author_facet Ardeleanu, Valeriu
Toma, Alexandra
Pafili, Kalliopi
Papanas, Nikolaos
Motofei, Ion
Diaconu, Camelia Cristina
Rizzo, Manfredi
Pantea Stoian, Anca
author_sort Ardeleanu, Valeriu
collection PubMed
description Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.
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spelling pubmed-70228692020-03-12 Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review Ardeleanu, Valeriu Toma, Alexandra Pafili, Kalliopi Papanas, Nikolaos Motofei, Ion Diaconu, Camelia Cristina Rizzo, Manfredi Pantea Stoian, Anca Medicina (Kaunas) Review Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms “distal symmetrical polyneuropathy”, “neuropathic pain treatment”, “diabetic neuropathy”, “diabetes complications”, ”glycaemic control”, “antidepressants”, “opioids”, and “anticonvulsants”. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice. MDPI 2020-01-09 /pmc/articles/PMC7022869/ /pubmed/31936646 http://dx.doi.org/10.3390/medicina56010025 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Ardeleanu, Valeriu
Toma, Alexandra
Pafili, Kalliopi
Papanas, Nikolaos
Motofei, Ion
Diaconu, Camelia Cristina
Rizzo, Manfredi
Pantea Stoian, Anca
Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
title Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
title_full Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
title_fullStr Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
title_full_unstemmed Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
title_short Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review
title_sort current pharmacological treatment of painful diabetic neuropathy: a narrative review
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7022869/
https://www.ncbi.nlm.nih.gov/pubmed/31936646
http://dx.doi.org/10.3390/medicina56010025
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