MINNEAPOLIS – Diabetic neuropathy refers to nerve damage due to diabetes and can cause pain and numbness, most commonly in the hands and feet. To help neurologists and other doctors determine the best treatment for people with diabetic neuropathy, the American Academy of Neurology (AAN) has issued a guideline on oral and topical treatments for painful diabetic neuropathy. The guideline will be published in the online edition of Neurology®, the AAN’s medical journal, December 27, 2021 and endorsed by the American Association of Neuromuscular & Electrodiagnostic Medicine. This guideline updates the 2011 AAN guideline for the treatment of painful diabetic neuropathy.
Living with pain can seriously affect a person’s quality of life. Therefore, this guideline is intended to assist neurologists and other physicians in ensuring the highest quality of patient care based on the latest knowledge. Painful diabetic neuropathy is very common, so diabetics with nerve pain should discuss this with their doctor as treatment can help.
Guideline author Brian C. Callaghan, MD, MS, of the University of Michigan at Ann Arbor and a Fellow of the American Academy of Neurology. “
The guideline states that there are many oral and topical medications that are effective in relieving nerve pain. Before prescribing any treatment, a doctor should first determine whether a person also has mood or sleep problems, as treating these conditions is also important.
For the relief of nerve pain, the guideline recommends that physicians offer treatments from the following drug classes: tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline and imipramine; Serotonin norepinephrine reuptake inhibitors (SNRIs) such as duloxetine, venlafaxine, or desvenlafaxine; Gabapentinoids such as gabapentin or pregabalin; and / or sodium channel blockers such as carbamazepine, oxcarbazepine, lamotrigine or lacosamide. There is evidence that these drugs can relieve all nerve pain.
New studies of sodium channel blockers that have been published since the last guideline have resulted in these drugs now being recommended and considered to be as effective at relieving pain as the other drug classes recommended in this guideline.
Brian Callaghan
The guideline says that when prescribing a prescription, doctors should consider the cost of a drug, side effects, and other medical problems the person may have. After taking any medication, patients should be evaluated by their doctors to determine if there is adequate pain relief or too many side effects.
If the first medication does not bring about any significant improvement or if there are significant side effects, doctors should offer the patient a study with a different drug of a different class in the guideline.
The guideline states that opioids should not be considered for treatment.
Current evidence suggests that the risks of using opioids to treat painful diabetic neuropathy outweigh the benefits, so they should not be prescribed.
Brian Callaghan.
The guideline states that doctors can offer topical treatments such as capsaicin, glyceryl trinitrate spray, or Citrullus colocynthis for pain relief. It also says that ginkgo biloba can be helpful, as well as non-drug treatments like exercise, mindfulness, cognitive behavioral therapy, or tai chi.
It is important to note that the medications and topical treatments recommended in this guideline may not eliminate pain, but have been shown to relieve pain. The good news is that there are many treatment options for painful diabetic neuropathy, so a treatment plan can be tailored specifically to each person with the condition.
Brian Callaghan.
To further support neurologists and other doctors in the treatment of painful diabetic neuropathy, the AAN has published a new AAN Polyneuropathy Quality Measurement Set in addition to this guideline. A quality measurement kit is a tool that doctors can use to improve patient care.
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