Advances in Pharmaceutical Options and Current Clinical Trials for the Treatment of Painful Diabetic Polyneuropathy

Fig. 11.1

A suggested algorithm for the management of patients with painful diabetic neuropathy (PDN). QOL quality of life, ALA α-lipoic acid, TENS transcutaneous electrical nerve stimulation. *Inadequate response is defined as pain reduction >30%

In summary, PDN is very common and can have a significant impact on patients QOL and the health-care economy. A somewhat confusing array of pharmacological options are currently available for the treatment of patients with PDN, with more in development which reflects the difficulties of achieving adequate pain relief in a significant number of patients. There is no universal agreement about the best first-line treatment and relative cost of therapies is also an important consideration. Patients need to be regularly screened for PDN (at least annually) and the impact of pain on mood, sleep patterns and daily activities assessed. Treatments should be individualized taking into account the risk–benefit ratio, the likely drug–drug interactions and the patient’s comorbidities. Better understanding of the pathogenesis of PDN and its natural history is needed in order to develop more targeted treatments with fewer side effects that may ultimately reduce the impact of this devastating complication of diabetes.

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