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
...Treatment...
...Initial...
...should assess patients with diabetes f...
...pharmacologic intervention for painfu...
...ans should assess patients with painful...
...h painful diabetic neuropathy, clin...
Clinicians may assess patient preferenc...
...ients preferring topical, nontraditional, or n...
...iven similar efficacy, clinicians shou...
...ts of child-bearing potential with p...
...patients with painful diabetic neuropathy, cli...
...should counsel patients that a series of medica...
Clinicians should determine that an individual int...
...Medicatio...
...ans should offer patients a trial of a m...
...s who achieve partial improvement with an initi...
...cians should NOT use opioids for the...
...ts are currently on opioids for the treatment of p...
...nicians should NOT use tramadol and tapentad...
...ients are currently on tramadol and tapentad...
...ion Dosage and Duration Information...
...ure 1. Class Effects for the Most W...