Volume 3, Issue 4 pp. 345-352.e21
Special Feature

Evidence-based Guideline: Treatment of Painful Diabetic Neuropathy

Report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation

First published: 14 April 2011
Citations: 73
Published simultaneously in Neurology and Muscle & Nerve. Approved by the AAN Quality Standards Subcommittee on November 13, 2010; by the AAN Practice Committee on December 15, 2010; by the AAN Board of Directors on February 10, 2011; by the Neuromuscular Guidelines Steering Committee on October 8,2010; by the AANEM Practice Issues Review Panel on January 15, 2011; by the AANEM Board of Directors on February 15, 2011; by the AAPM&R Quality Practice & Policy Committee on February 6, 2011; and by the AAPM&R Board of Governors on March 11, 2011.
Author affiliations and disclosures are provided. Supplemental data available at www.pmrjournal.org
DISCLOSURE Dr. Bril has received research support from Talecris Biotherapeutics, Eisai Inc., Pfizer Inc, Eli Lilly and Company, and Johnson & Johnson. Dr. England serves on the speakers' bureau for and has received funding for travel or speaker honoraria from Talecris Biotherapeutics and Teva Pharmaceutical Industries Ltd.; served as an Associate Editor for Current Treatment Options in Neurology; receives research support from the NIH/NINDS, Wyeth, Astra Zeneca, and Pfizer Inc; holds stock/stock options in Wyeth and Talecris Biotherapeutics; and has served as an expert witness in a medico-legal case. Dr. Franklin serves on the editorial board of Neuroepidemiology; serves as a consultant for the New Zealand Accident Fund; and serves as a consultant for the Workers Compensation Research Institute. Dr. Backonja served on a Safety Monitoring Board for Medtronic, Inc.; serves on the editorial boards of Clinical Journal of Pain, European Journal of Pain, Journal of Pain, Pain, and Pain Medicine; is listed as author on a patent re: A hand-held probe for suprathreshold thermal testing in patients with neuropathic pain and other neurological sensory disorders; serves as a consultant for Allergan, Inc., Astellas Pharma Inc., Eli Lilly and Company, Medtronic, Inc., Merck Serono, NeurogesX, Pfizer Inc, and SK Laboratories, Inc.; and receives research support from NeurogesX. Dr. Cohen serves on an FDA Peripheral and Central Nervous System Drugs Advisory Committee; receives publishing royalties for What Would You Do Now? Neuromuscular Disease (Oxford University Press, 2009); estimates that he performs clinical neurophysiology testing as 50% of his clinical practice; and has given expert testimony, prepared an affidavit, and acted as a witness in a legal proceeding with regard to vaccinerelated injuries and peripheral nerve injuries. Dr. Del Toro receives research support from the NIH. Dr. Feldman serves on a Data Safety and Monitoring Board for Novartis; serves on the editorial boards of Annals of Neurology and the Journal of the Peripheral Nervous System; receives publishing royalties from UpToDate; and receives research support from the NIH, the Taubman Research Institute, and the American Diabetes Association. Dr. Iverson serves as editor of Neuro PI and has been a treating expert witness with regard to a legal proceeding. Dr. Perkins has received research support from Medtronic, Inc., the Canadian Institutes of Health Research, the Juvenile Diabetes Research Foundation, and the Canadian Diabetes Association. Dr. Russell has received honoraria from Exelixis Inc. and Baxter International Inc.; and receives research support from Baxter International Inc., the NIH, the US Veterans Administration, the American Diabetes Association, and the Juvenile Diabetes Foundation. Dr. Zochodne serves on a scientific advisory board for and holds stock options in Aegera Therapeutics Inc.; has received honoraria from Ono Pharmaceutical Co. Ltd.; receives publishing royalties for Neurobiology of Peripheral Nerve Regeneration (Cambridge University Press, 2008); has received research support from the Canadian Institutes of Health Research, the Canadian Diabetes Association, the Juvenile Diabetes Research Foundation, the National Science and Engineering Research Council, the NIH, and the Alberta Heritage Foundation for Medical Research, Baxter International Inc., and Aegera Therapeutics Inc.; and has served as a co-PI on industry trials with Valeant Pharmaceuticals International and Pfizer Inc.
Send correspondence to: American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116, e-mail: [email protected]

Abstract

Objective

To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN).

Methods

We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: “What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; and non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?”

Results and Recommendations

Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulphate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.

The full text of this article hosted at iucr.org is unavailable due to technical difficulties.