Review of the symptomatic treatment of diabetic neuropathy

References were selected from a MEDLINE search from 1966-1993 for literature evaluating the drug therapy of diabetic peripheral neuropathy (DPN). The search was limited to studies evaluating symptomatic treatment, and methods were developed to include only well-designed clinical trials. Many recommendations for the symptomatic treatment of DPN appear in the medical literature, but are frequently based on case reports, information extrapolated from other neuropathic pain syndrome models, or treatment protocols lacking scientific methods. These recommendations include antidepressants, sodium channel antagonists, topical capsaicin, and miscellaneous agents. Anti-depressants are considered to be the first choice in these patients. Factors to consider in establishing a regimen are interpretation of studies, adverse drug effects, drug-drug and drug-disease interactions, convenience of administration, and cost of therapy. Potentially effective alternatives were determined from the reviewed trials.