《疼痛性糖尿病多发性神经病的口服和局部治疗：实践指南更新概要：AAN 指南小组委员会的报告》。

Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee.

机构信息

From the Department of Neurology (R.P.), University of Pennsylvania, Philadelphia; Department of Neurology (D.S.), University of Colorado, Aurora; Department of Neurology (G.F.), University of Washington, Seattle; Department of Neurology (G.G.), University of Kansas Medical Center, Kansas City; Department of Internal Medicine (M.P.), The University of Texas at Austin Dell Medical School; Department of Neurology (W.S.D.), Massachusetts General Hospital, Boston; Department of Neurology (C.A.), Tel Aviv University Sackler School of Medicine and Shamir (Assaf Harofeh) Medical Center, Israel; Leadership Sinai Centre for Diabetes (B.A.P.), Sinai Health System, University of Toronto; Division of Neurology (V.B.), Department of Medicine, Toronto General Hospital, Canada; Professor Emeritus (A.R.-G.), Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, OH; Department of Neurosciences (J.H.), Overlook Medical Center, Summit, NJ; New West Physicians (N.L.), Golden, CO; American Academy of Neurology (M.D.O., S.R.W.), Minneapolis, MN; Neuropathy Action Foundation (L.C.M.), Santa Ana, CA; Kamehameha Schools (K.F.), Honolulu, HI; University of Texas Rio Grande Valley School of Podiatric Medicine (L.B.H.), Edinburg; The Foundation for Peripheral Neuropathy (L.C.), Buffalo Grove, IL; and Department of Neurology (B.C.C.), University of Michigan, Ann Arbor.

出版信息

Neurology. 2022 Jan 4;98(1):31-43. doi: 10.1212/WNL.0000000000013038.

DOI:10.1212/WNL.0000000000013038

PMID:34965987

Abstract

OBJECTIVE

To update the 2011 American Academy of Neurology (AAN) guideline on the treatment of painful diabetic neuropathy (PDN) with a focus on topical and oral medications and medical class effects.

METHODS

The authors systematically searched the literature from January 2008 to April 2020 using a structured review process to classify the evidence and develop practice recommendations using the AAN 2017 Clinical Practice Guideline Process Manual.

RESULTS

Gabapentinoids (standardized mean difference [SMD] 0.44; 95% confidence interval [CI], 0.21-0.67), serotonin-norepinephrine reuptake inhibitors (SNRIs) (SMD 0.47; 95% CI, 0.34-0.60), sodium channel blockers (SMD 0.56; 95% CI, 0.25-0.87), and SNRI/opioid dual mechanism agents (SMD 0.62; 95% CI, 0.38-0.86) all have comparable effect sizes just above or just below our cutoff for a medium effect size (SMD 0.5). Tricyclic antidepressants (TCAs) (SMD 0.95; 95% CI, 0.15-1.8) have a large effect size, but this result is tempered by a low confidence in the estimate.

RECOMMENDATIONS SUMMARY

Clinicians should assess patients with diabetes for PDN (Level B) and those with PDN for concurrent mood and sleep disorders (Level B). In patients with PDN, clinicians should offer TCAs, SNRIs, gabapentinoids, and/or sodium channel blockers to reduce pain (Level B) and consider factors other than efficacy (Level B). Clinicians should offer patients a trial of medication from a different effective class when they do not achieve meaningful improvement or experience significant adverse effects with the initial therapeutic class (Level B) and not use opioids for the treatment of PDN (Level B).

摘要

目的

根据 2011 年美国神经病学学会（AAN）治疗痛性糖尿病周围神经病变（PDN）的指南进行更新，重点关注局部和口服药物以及医学类药物的作用。

方法

作者采用结构化审查程序，从 2008 年 1 月至 2020 年 4 月系统地搜索文献，对证据进行分类，并使用 AAN 2017 年临床实践指南制定过程手册制定实践建议。

结果

加巴喷丁类（标准化均数差[SMD]0.44；95%置信区间[CI]，0.21-0.67）、血清素-去甲肾上腺素再摄取抑制剂（SNRIs）（SMD 0.47；95%CI，0.34-0.60）、钠离子通道阻滞剂（SMD 0.56；95%CI，0.25-0.87）和 SNRIs/阿片类双重作用机制药物（SMD 0.62；95%CI，0.38-0.86）的疗效大小均接近或略高于我们设定的中等疗效大小（SMD 0.5）的临界值。三环类抗抑郁药（TCAs）（SMD 0.95；95%CI，0.15-1.8）具有较大的疗效大小，但由于估计值置信度低，该结果受到限制。