Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management

Figures & data

Table 1 Recent Guidelines for Pharmacotherapy of Painful Diabetic Peripheral Neuropathy

		AACE (2022)^Citation12	AAN (2022)^Citation30	ADA (2017)^Citation4	DC (2018)^Citation83	DDG (2021)^Citation84	IDF (2022)^Citation41
Tricyclic antidepressants	Amitriptyline	1	1	NR	2	1	1
	Nortriptyline	1	1	1	–	1	1
SNRIs	Duloxetine	1	1	1	2	1	1
	Venlafaxine	1	1	1	2	–	1
Gabapentinoids	Pregabalin	1	1	1	1	1	1
	Gabapentin	1	1	1	2	1	1
Sodium channel blockers	Carbamazepine	–	1	–	–	–	–
	Oxcarbazepine	–	1	–	–	–	–
	Lamotrigine	–	1	–	–	–	–
	Valproate	–	2	–	1	–	–
	Lacosamide	–	1	–	–	–	–
SNRI/opioid dual mechanism agents	Tramadol	NR	NR	3	3	1	2
	Tapentadol	NR	NR	3	3	–	3
Opioids		NR	NR	3	3	2	3
Capsaicin 8% patch		1	1	–	–	1	3
Lidocaine 5% infusion		–	–	–	–	–	–
α-Lipoic acid		–	NR	NR	–	1	3

Notes: Key: 1 = first line, 2 = second line, 3 = third line, NR = not recommended, – = not considered.

Abbreviations: AACE, American Association of Clinical Endocrinology; AAN, American Academy of Neurology; ADA, American Diabetes Association; DC, Diabetes Canada; DDG, German Diabetes Association; SNRIs, serotonin and norepinephrine reuptake inhibitors.

Figure 1 Painful diabetic peripheral neuropathy treatment algorithm.

Notes: *Pregabalin is preferred due to pre-dosing regimen being available. **Tramadol can be utilised for breakthrough pain in addition to pregabalin for patients with severe pain at presentation.

Abbreviations: SNRI, serotonin and norepinephrine reuptake inhibitors; TCA, tricyclic antidepressant.

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