Painful Diabetic Polyneuropathy: Approach to Diagnosis and Management

OBJECTIVES:: To provide a current overview of the diagnostic work-up and management of painful diabetic polyneuropathy (PDPN). METHODS:: A review covering the literature from 2004 to 2011, which describes the tools designed to diagnose neuropathic pain and assess its severity, including self-administered questionnaires, validated laboratory tests and simple handheld screening devices, and the evidence-based therapeutic approaches to PDPN. RESULTS:: The clinical aspects, pathogenesis, and comorbidities of PDPN, as well as its impact on health related quality of life (HR-QoL), are the main drivers for the management of patients with suspected PDPN. PDPN treatment consists first of all in improving glycemic control and lifestyle intervention. A number of symptomatic pharmacological agents are available for pain control: tricyclic antidepressants and selective serotonin norepinephrine reuptake inhibitors (venlafaxine and duloxetine), α2-delta ligands (gabapentin and pregabalin), opioid analgesics (tramadol and oxycodone), and agents for topical use, such as lidocaine patch and capsaicin cream. With the exception of transcutaneous electrical nerve stimulation, physical treatment is not supported by adequate evidence. DISCUSSION:: As efficacy and tolerability of current therapy for PDPN are not ideal, the need for a better approach in management further exists. Novel compounds should be developed for the treatment of PDPN.