Painful Diabetic Polyneuropathy
Key Points
Key Points
- Clinicians should offer tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), gabapentinoids, and/or sodium channel blockers to reduce pain.
- Clinicians should not use opioids for the treatment of painful diabetic neuropathy.
- For patients with painful diabetic neuropathy, clinicians should review all of the available options to reduce pain, including oral, topical, and nonpharmacologic interventions.
- It is important for clinicians to think about treatment of painful diabetic neuropathy in terms of medication class. Patients need to be re-evaluated, in regard to efficacy and tolerability, after starting treatment. If a medication in one class is not working or is causing intolerable side effects, another medication class should be tried instead of another medication in the same class.
Treatment
...eatmen...
...nitial Assessment
...should assess patients with diabetes for p...
...n initiating pharmacologic interventi...
...icians should assess patients with painf...
...with painful diabetic neuropathy, clinicians sho...
...s may assess patient preferences for e...
...ients preferring topical, nontraditional,...
Given similar efficacy, clinicians shou...
...patients of child-bearing potential...
...l patients with painful diabetic neuropa...
...uld counsel patients that a series...
Clinicians should determine that an individu...
Medication
...icians should offer patients a trial of a medica...
...achieve partial improvement with an initia...
...linicians should NOT use opioids for the treat...
...e currently on opioids for the treatment of...
...should NOT use tramadol and tapentadol (opioids/S...
...ts are currently on tramadol and tap...
...edication Dosage and Duration Informati...
...lass Effects for the Most Well-Studied Ora...