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 Asses...
...ns should assess patients with diabe...
...n initiating pharmacologic intervention f...
...d assess patients with painful diabetic neuropat...
...patients with painful diabetic neuropathy, clin...
...may assess patient preferences for effective o...
...ts preferring topical, nontraditional,...
Given similar efficacy, clinicians sho...
...s of child-bearing potential with painful...
...tients with painful diabetic neuropathy, clinic...
...icians should counsel patients that a series...
...should determine that an individual interven...
...Medica...
...nicians should offer patients a trial of a...
...ients who achieve partial improvement with...
...ld NOT use opioids for the treatment of painful di...
...tients are currently on opioids for the tre...
...cians should NOT use tramadol and tapentadol...
...currently on tramadol and tapentad...
...cation Dosage and Duration InformationHav...
.... Class Effects for the Most Well-Studied Ora...