Endocrinology, Department of Internal Medicine, Tor Vergata University, Rome, Italy.
Clin J Pain. 2012 Oct;28(8):726-43. doi: 10.1097/AJP.0b013e318243075c.
To provide a current overview of the diagnostic work-up and management of painful diabetic polyneuropathy (PDPN).
A review covering the literature from 2004 to 2011, which describes the tools designed to diagnose neuropathic pain and assess its severity, including self-administered questionnaires, validated laboratory tests and simple handheld screening devices, and the evidence-based therapeutic approaches to PDPN.
The clinical aspects, pathogenesis, and comorbidities of PDPN, as well as its impact on health related quality of life (HR-QoL), are the main drivers for the management of patients with suspected PDPN. PDPN treatment consists first of all in improving glycemic control and lifestyle intervention. A number of symptomatic pharmacological agents are available for pain control: tricyclic antidepressants and selective serotonin norepinephrine reuptake inhibitors (venlafaxine and duloxetine), α2-delta ligands (gabapentin and pregabalin), opioid analgesics (tramadol and oxycodone), and agents for topical use, such as lidocaine patch and capsaicin cream. With the exception of transcutaneous electrical nerve stimulation, physical treatment is not supported by adequate evidence.
As efficacy and tolerability of current therapy for PDPN are not ideal, the need for a better approach in management further exists. Novel compounds should be developed for the treatment of PDPN.
提供一个有关诊断性检查和痛性糖尿病周围神经病（PDPN）管理的最新概述。
综述了 2004 年至 2011 年的文献，描述了用于诊断神经病理性疼痛和评估其严重程度的工具，包括自我管理问卷、经过验证的实验室检查和简单的手持式筛查设备，以及基于证据的 PDPN 治疗方法。
PDPN 的临床方面、发病机制和合并症，以及对健康相关生活质量（HR-QoL）的影响，是管理疑似 PDPN 患者的主要驱动力。PDPN 的治疗首先包括改善血糖控制和生活方式干预。有许多对症药物可用于控制疼痛：三环类抗抑郁药和选择性 5-羟色胺和去甲肾上腺素再摄取抑制剂（文拉法辛和度洛西汀）、α2-δ 配体（加巴喷丁和普瑞巴林）、阿片类镇痛药（曲马多和羟考酮）和局部用药物，如利多卡因贴剂和辣椒素乳膏。除经皮电神经刺激外，物理治疗没有足够的证据支持。
由于目前治疗 PDPN 的疗效和耐受性不理想，因此需要进一步改进管理方法。应该开发新的化合物来治疗 PDPN。
