Topical treatments for diabetic neuropathic pain

Abstract

Diabetic neuropathic pain (DNP) has a huge impact on quality of life and can be difficult to treat. Oral treatment is the most frequently used method for DNP, but its use is often limited by systemic side effects. Topical use of drugs as an alternative option for DNP treatment is currently gaining interest. In the present review, a summary is provided of the available agents for topical use in patients with DNP, including lidocaine plasters or patches, capsaicin cream, gel or patches, amitriptyline cream, clonidine gel, ketamine cream, extracts from medicinal plants including nutmeg extracts and Citrullus colocynthis extract oil, and certain compounded topical analgesics. Furthermore, the potential efficacy of these treatments is addressed according to the available clinical research literature. It has been indicated that these topical drugs have the potential to be valuable additional options for the management of DNP, with adequate safety and continuous long-term treatment efficacy. Compounded topical agents are also effective and safe for patients with DNP and could be another area worthy of further investigation based on the strategy of using low-dose, complementary therapies for DNP. The findings indicate that developing topical drugs acting on different targets in the process of DNP is a valuable area of future research.

Keywords: diabetes; diabetic neuropathic pain; diabetic neuropathy; topical treatments.

Figure 1.

A summary of the pathogenesis of DNP. DNP, diabetic neuropathic pain; AGEs, advanced glycation end-products; TRPV1, transient receptor potential vanilloid 1.

Figure 2.

Therapeutic targets of topical agents for DNP. AGEs, advanced glycation end-products; ROS, reactive oxygen species; TRPV1, transient receptor potential vanilloid 1; AMPA, a-amino-3-hydroxy-5-methylisoxazole-4-proprionic acid; NMDA, N-methyl-D-aspartate; DNP, diabetic neuropathic pain.