Painful diabetic neuropathy is a common and troubling complication of diabetes. Many current treatments are based on anecdotal reports or relatively small clinical trials in which the efficacy of the agents is questionable, reflecting the fact that none is specifically licensed for the management of painful diabetic neuropathy. Despite these limitations the authors provide a practical algorithm based on a number needed to treat analysis together with an assessment of drug safety. We advocate an improvement in overall glycaemic control together with a reduction in glucose flux, coupled with a stepwise approach starting with a tricyclic, followed by gabapentin, tramadol and carbamazepine. We do not recommend combination treatment.
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism