Department of Neurosurgery, Albany Medical College, Albany, New York, USA.
Department of Neuroscience and Experimental Therapeutics, Albany Medical College, Albany NY, USA.
J Diabetes Sci Technol. 2022 Mar;16(2):341-352. doi: 10.1177/1932296820951829. Epub 2020 Aug 28.
The development of painful diabetic neuropathy (PDN) is a common complication of chronic diabetes that can be associated with significant disability and healthcare costs. Prompt symptom identification and aggressive glycemic control is essential in controlling the development of neuropathic complications; however, adequate pain relief remains challenging and there are considerable unmet needs in this patient population. Although guidelines have been established regarding the pharmacological management of PDN, pain control is inadequate or refractory in a high proportion of patients. Pharmacotherapy with anticonvulsants (pregabalin, gabapentin) and antidepressants (duloxetine) are common first-line agents. The use of oral opioids is associated with considerable morbidity and mortality and can also lead to opioid-induced hyperalgesia. Their use is therefore discouraged. There is an emerging role for neuromodulation treatment modalities including intrathecal drug delivery, spinal cord stimulation, and dorsal root ganglion stimulation. Furthermore, consideration of holistic alternative therapies such as yoga and acupuncture may augment a multidisciplinary treatment approach. This aim of this review is to focus on the current management strategies for the treatment of PDN, with a discussion of treatment rationale and practical considerations for their implementation.
糖尿病性疼痛性神经病变（PDN）的发展是慢性糖尿病的一种常见并发症，可导致显著的残疾和医疗保健费用。及时识别症状和积极控制血糖对于控制神经病变并发症的发展至关重要；然而，充分缓解疼痛仍然具有挑战性，这一患者群体存在着大量未满足的需求。尽管已经制定了关于 PDN 药物治疗的指南，但相当一部分患者的疼痛控制效果不佳或无法缓解。抗惊厥药（普瑞巴林、加巴喷丁）和抗抑郁药（度洛西汀）是常见的一线药物。口服阿片类药物的使用与相当大的发病率和死亡率相关，并且还可能导致阿片类药物引起的痛觉过敏。因此，不鼓励使用。神经调节治疗方法（包括鞘内药物输送、脊髓刺激和背根神经节刺激）的作用正在出现。此外，考虑瑜伽和针灸等整体替代疗法可能会增强多学科治疗方法。本综述的目的是重点关注 PDN 的当前治疗管理策略，讨论治疗原理和实施的实际考虑因素。
