Therapeutic Research

Abstract

Diabetic peripheral neuropathies(DPNs)are common complications of diabetes. Pain with DPNs causes unbearable distress(sleep disruption, depressive state, and deterioration of quality of life)to diabetic patients. Traditionally, tricyclic antidepressants(TCAs), certain anticonvulsants, and mexiletine have been recommended for treating moderate to severe forms of PDN. Recently, calcium channel α2δ ligand pregabalin and the selective serotonin and noradrenaline reuptake inhibitor duloxetine have been shown efficacious and safe among patients with painful DPNs. Most of the guidelines for neuropathic pain recommend pregabalin, duloxetine, and TCAs as the first-line treatment for diabetic neuropathic pain. While these recommendations are mainly for chronic neuropathic pain with typical diabetic sensorimotor polyneuropathy(DSPN), we have no evidence for severe neuropathic pain in atypical DPNs such as acute painful diabetic neuropathies or focal/multifocal diabetic neuropathies. Although we prescribe analgesic agents for these conditions in reference to typical DPN, we often have some troubles associate with diabetic autonomic neuropathy including orthostatic hypotension. There is no significant difference in analgesic efficacy between pregabalin, duloxetine and TCA, duloxetine seems to be safe and advantageous especially in the management for painful DPNs with autonomic neuropathy. Then we discuss on the treatment algorithm on the management for pain with diabetic neuropathies.