Neurológia pre prax 5/2012

Painful diabetic neuropathy – evidence-based therapy

Painful diabetic neuropathy developes in 16 % of all diabetics and in 40–50 % of diabetics with previously diagnosed diabetic neuropathy. Various medicaments are used in treatment of neuropatic pain in painful diabetic neuropathy: antidepressants, anticonvulsants, opioids, topically administered drugs, other medicaments and non-pharmacological procedures. According to evidence of pain-relieving effects in painful diabetic neuropathy there were evaluted more than 2000 citations, the titles and abstracts of which 79 were chosen, that fulfilled all the criteria of evaluating panel (from AAN – American Academy of Neurology). The highest level of recommendation (level A) reached pregabalin, then duloxetine (with respect to its adverse events, level B), then venlafaxine, tricyclic antidepressants, gabapentin, opioids, capsaicin. The combination of drugs is successful (e.g. with opioids).

Keywords: neuropathic pain, diabetic neuropathy, antidepressants, anticovulsants, opioids, topical agents.