Neurológia pre prax 6/2017

How are patients with painful diabetic polyneuropathy treated?

Introduction: Painful diabetic polyneuropathy (PDPN) is a frequent complication of diabetes; however, its severity is usually underestimated and it is often not managed adequately. The aim of the study was to evaluate whether patients with PDPN were receiving treatment for neuropathic pain and what the treatment response was. Methods: This is a retrospective evaluation of baseline data obtained from an observational, cross-sectional, multicentre cohort study. The study included 232 patients with diabetic polyneuropathy associated with type 1 or type 2 diabetes (92 women, median age 63 years, age range 21–87 years). The occurrence of PDPN was determined and treatment of neuropathic pain was analysed. Patients with pain were divided into the following subgroups: untreated (naive), responders to treatment, non-responders to treatment. Results: The study cohort included 157 (67.7 %) PDPN patients, with 127 patients (54.7 %) reporting moderate to severe pain (NRS ≥ 4). In the group of PDPN patients with NRS ≥ 4, sixty-nine (54.3 %) were receiving treatment for neuropathic pain and 58 (45.7 %) patients were untreated. There were 39 responders to treatment (56.5 %) and 30 non-responders to treatment (43.5 %). Monotherapy was the preferred type of treatment for PDPN (76.2 % of patients), with gabapentin (54 % of patients) and pregabalin (20.6 % of patients) being the most commonly used agents. Conclusion: The treatment for PDPN was not satisfactory (46 % of patients with moderate to severe pain failed to receive treatment for neuropathic pain; poor response to treatment for neuropathic pain was shown in 44 % of patients). The predominant type of treatment for neuropathic pain was monotherapy, with gabapentin and pregabalin being the most commonly used agents.

Keywords: diabetes mellitus, polyneuropathy, pain