Advances in the management of diabetic peripheral neuropathy

Over the past 5 years there have been significant advances in the pathogenesis and management of diabetic peripheral neuropathic pain (DPNP) and this review attempts to summarize these.

Recent research has shown that in addition to poor glucose control, traditional cardiovascular risk factors for macrovascular disease, are independent-risk factors for incident diabetic peripheral neuropathy (DPN). In contrast, the risk factors for DPNP are not known although data from the EURODIAB cohort suggest that female sex may be an independent-risk factor. The pathogenisis of pain in DPNP is also not clear although differences in sural nerve epineurial blood flow, foot skin microcirculation and intraepidermal nerve fibre density (IENF), and thalamic magnetic resonance spectroscopy have been demonstrated between individuals with DPNP and painless neuropathy.Pharmacological treatment of DPNP includes tricyclic compounds (TCAs), selective serotonin noradrenaline reuptake inhibitors (SNRIs), anticonvulsants, opiates, membrane stabilizers, the antioxidant alpha lipoic acid, capsaicin etc. Current first-line therapies for DPNP are a TCA, SNRI (such as duloxetine) or anticonvulsants (such as pregabalin or gabapentin), taking into account patient comorbidities and cost.

There has recently been a consensus document suggesting an evidence-based protocol for the management of DPNP and this report is highlighted.