Updated guidelines from the American Academy of Neurology (AAN) caution against prescribing opioids to treat painful diabetic neuropathy (PDN) -However, note that a variety of other treatments, both topical and oral, can alleviate pain.
PDN is quite common and can significantly impact an individual’s quality of life The guideline’s author Brian Callaghan, MD, University of Michigan in Ann Arbor, noted in a press release.
Callaghan stated that the guidelines were created to aid neurologists and other doctors in providing the best possible patient care, based upon the most current evidence.
These recommendations are an update of the 2011 AAN guideline for the treatment of PDN. The American Association of Neuromuscular and Electrodiagnostic Medicine (AAN) endorsed the new guidelines , which was published online on December 27, 2012 in Neurology.
Multiple Options
To refresh the guideline, an expert panel reviewed data from more than 100 random controlled trials that were that were published between January 2008 and April 2020.
The panel also notes that more than 16% of individuals who suffer from diabetes have PDN, but it often is not recognized and treated.
The guidelines suggest that doctors evaluate patients with diabetes for pain from peripheral neuropathy and its effects on their functioning and quality of life.
Health providers should assess the patient’s mood and sleep issues before prescribing treatment. Both can impact the perception of pain.
The guideline recommends offering one of four classes of oral medications found to be effective for neuropathic pain: tricyclic antidepressants such as amitriptyline, nortriptyline, or imipramine; serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine, venlafaxine, or desvenlafaxine; gabapentinoids such as gabapentin, or pregabalin; and/or sodium channel blockers such as carbamazepine, oxcarbazepine, lamotrigine, or lacosamide.
All four classes of medications contain “comparable effect sizes that are either just above or just below our cutoffs for a medium effect size” (standardized median difference, 0.5), the panel notes.
Furthermore, “new studies on sodium channel blockers that have been published since the last guideline have resulted in these drugs being recommended and deemed as effective at offering pain relief as other classes of drugs recommended in this guideline,” said Callaghan.
When an initial medication does not provide significant improvement in pain, or produces significant side effects, a trial of another medication from a different class is recommended.
Pain Reduction, Not Elimination
PDN is not recommended using opioids. The panel says there is no evidence to prove their effectiveness for PDN long-term.
Tramadol or tapentadol should not be used for PDN treatment.
Callaghan stated that the latest evidence suggests that opioids for the treatment of painful diabetic neuropathy are not safe.
If you are a patient who is who are interested in trying topical, nontraditional, or non-pharmacological treatments to lessen pain, the guideline suggests various options such as capsaicin, glyceryl trinitrate spray, and Citrullus colocynthis. Ginkgo biloba and mindfulness, cognitive behavior therapy, tai-chi and exercise are all suggested.
“It is important to note that the prescribed drugs and topical treatments listed in this guideline are not guaranteed to eliminate pain however, they have been shown to ease pain,” Callaghan said.
“The good news is that there are many treatment options available for painful diabetic neuropathy, so a treatment plan could be customized for the individual suffering from this disease,” he said.
Along with the updated guideline along with the updated guideline, the AAN has also released the new AAN Polyneuropathy Quality Measurement Set to assist neurologists and other healthcare professionals in treating patients suffering from PDN.
The updated guideline was developed with financial assistance from the AAN.
Neurology. Published online December 27 2021. Full article
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