Gupta Mayank, Knezevic Nebojsa Nick, Abd-Elsayed Alaa, Ray Mahoua, Patel Kiran, Chowdhury Bhavika
Kansas Pain Management & Neuroscience Research Center, Overland Park, KS 66201, USA.
Department of Anesthesiology, Advocate Illinois Masonic Medical Center, Chicago, IL 60657, USA.
Biomedicines. 2021 May 19;9(5):573. doi: 10.3390/biomedicines9050573.
Painful diabetic neuropathy (PDN) is a common complication of diabetes mellitus that is associated with a significant decline in quality of life. Like other painful neuropathic conditions, PDN is difficult to manage clinically, and a variety of pharmacological and non-pharmacological options are available for this condition. Recommended pharmacotherapies include anticonvulsive agents, antidepressant drugs, and topical capsaicin; and tapentadol, which combines opioid agonism and norepinephrine reuptake inhibition, has also recently been approved for use. Additionally, several neuromodulation therapies have been successfully used for pain relief in PDN, including intrathecal therapy, transcutaneous electrical nerve stimulation (TENS), and spinal cord stimulation (SCS). Recently, 10 kHz SCS has been shown to provide clinically meaningful pain relief for patients refractory to conventional medical management, with a subset of patients demonstrating improvement in neurological function. This literature review is intended to discuss the dosage and prospective data associated with pain management therapies for PDN.
痛性糖尿病神经病变（PDN）是糖尿病的一种常见并发症，与生活质量显著下降相关。与其他疼痛性神经病变一样，PDN在临床上难以处理，针对这种情况有多种药物和非药物治疗选择。推荐的药物治疗包括抗惊厥药、抗抑郁药和局部辣椒素；最近，兼具阿片类激动作用和去甲肾上腺素再摄取抑制作用的曲马多也已获批使用。此外，几种神经调节疗法已成功用于缓解PDN的疼痛，包括鞘内治疗、经皮电刺激神经疗法（TENS）和脊髓刺激（SCS）。最近的研究表明，10 kHz的SCS可为传统药物治疗无效的患者提供具有临床意义的疼痛缓解，部分患者的神经功能也有所改善。这篇文献综述旨在讨论与PDN疼痛管理疗法相关的剂量和前瞻性数据。
