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
...eatment...
...al Assessment...
...ld assess patients with diabetes for periphe...
...hen initiating pharmacologic intervention...
...ans should assess patients with painful diabeti...
...ients with painful diabetic neuropathy, clinici...
...ssess patient preferences for effe...
...atients preferring topical, nontraditional, or...
...lar efficacy, clinicians should co...
...patients of child-bearing potential with...
...patients with painful diabetic neuropathy...
...ans should counsel patients that a series of medic...
...ns should determine that an individual...
...ication...
...uld offer patients a trial of a medication from a...
...patients who achieve partial improvement...
...nicians should NOT use opioids for...
...ents are currently on opioids for the...
...linicians should NOT use tramadol and tapentadol...
...re currently on tramadol and tapentadol (opi...
...tion Dosage and Duration InformationHaving troubl...
...1. Class Effects for the Most Well-Studied...