AAN Issues Guideline for Treatment of Painful Diabetic Neuropathy

The Academy of Neurology (AAN) has issued a new guideline on oral and topical treatments for painful diabetic neuropathy to help neurologists and other physicians determine the best treatment for patients with diabetic neuropathy. This is an update to the 2011 AAN guideline on the treatment of painful diabetic neuropathy, according to a press release.

“Living with pain can greatly affect a person’s quality of life, so this guideline aims to help neurologists and other doctors provide the highest quality patient care based on the latest evidence,” said guideline author Brian C. Callaghan, MD, MS, in the press release. “Painful diabetic neuropathy is very common, so people with diabetes who have nerve pain should discuss it with their doctor because treatment may help.”

The guideline update states that there are many oral and topical medications that are effective in reducing nerve pain, and before prescribing a treatment, a physician should first determine whether a person has mood or sleep problems because treatment for these conditions is essential.

Additionally, to reduce nerve pain, the guideline recommends that physicians may offer treatments from the following drug classes:

• Tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline, and imipramine.
• Serotonin-norepinephrine reuptake inhibitors, such as duloxetine, venlafaxine, or desvenlafaxine.
• Gabapentinoids such as gabapentin or pregabalin.
• Sodium channel blockers such as carbamazepine, oxcarbazepine, lamotrigine, or lacosamide.

“New studies on sodium channel blockers published since the last guideline have resulted in these drugs now being recommended and considered as effective at providing pain relief as the other drug classes recommended in this guideline,” Callaghan said in the press release.

When prescribing, the guideline states that physicians should consider the cost of a drug, adverse effects (AEs) and other medical problems the patient may have, and once taking a drug, patients should be looked at by their physicians to determine whether there is enough pain relief or too many AEs.

If the first medication does not provide meaningful improvement, or if there are significant AEs, the guideline states that physicians should offer patients a trial of another medication from a different class. Further, opioids should not be considered for treatment.

Topical treatments, such as capsaicin, glyceryl trinitrate spray, or Citrullus colocynthis, may be offered to reduce pain. Non-drug treatments, such as exercise and cognitive behavioral therapy, may also be helpful, according to the guideline.

“It is important to note that the recommended drugs and topical treatments in this guideline may not eliminate pain, but they have been shown to reduce pain,” Callaghan said in the press release. “The good news is there are many treatment options for painful diabetic neuropathy, so a treatment plan can be tailored specifically to each person living with this condition.”

The AAN has additionally published a new Polyneuropathy Quality Measurement Set to accompany this guideline, which is a tool that physicians can use to improve the ways in which care is delivered to patients, according to the press release.

REFERENCE

AAN Issues Guideline for Treatment of Painful Diabetic Neuropathy. Newswise. December 26, 2021. Accessed January 3, 2022. https://www.newswise.com/articles/aan-issues-guideline-for-treatment-of-painful-diabetic-neuropathy