Effective treatment pathways exist for DPNP

Diabetic neuropathy affects 8–25% of patients with type 2 diabetes, but this rises to 42% in those followed up for 10 years. 1 Callaghan BC Price RS Feldman EL Distal symmetric polyneuropathy: a review. JAMA. 2015; 314: 2172-2181 Crossref PubMed Scopus (131) Google Scholar Pain is common in diabetic neuropathy, with almost half of these patients having neuropathic pain. 2 Kaur S Pandhi P Dutta P Painful diabetic neuropathy: an update. Ann Neurosci. 2011; 18: 168-175 Crossref PubMed Scopus (47) Google Scholar Additionally, diabetic peripheral neuropathic pain (DPNP) is an independent risk factor for worse quality of life, depression, anxiety, and sleep. 3 Gylfadottir SS Christensen DH Nicolaisen SK et al. Diabetic polyneuropathy and pain, prevalence, and patient characteristics: a cross-sectional questionnaire study of 5,514 patients with recently diagnosed type 2 diabetes. Pain. 2020; 161: 574-583 Crossref PubMed Scopus (26) Google Scholar The 2022 guideline from the American Academy of Neurology recommended that gabapentinoids, serotonin reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and sodium channel blockers are all effective at reducing neuropathic pain in DPNP. 4 Price R Smith D Franklin G et al. Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary: report of the AAN guideline subcommittee. Neurology. 2022; 98: 31-43 Crossref PubMed Scopus (8) Google Scholar This guideline also highlighted current limitations in the literature including a scarcity of comparative effectiveness studies; studies with quality of life, depression, anxiety, and sleep outcomes; data on combination therapy; and long-term studies. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trialTo our knowledge, this was the largest and longest ever, head-to-head, crossover neuropathic pain trial. We showed that all three treatment pathways and monotherapies had similar analgesic efficacy. Combination treatment was well tolerated and led to improved pain relief in patients with suboptimal pain control with a monotherapy. Full-Text PDF Open Access