Pharmacological Treatment of Diabetic Peripheral Neuropathy: An Update

Abstract

Neuropathy is the most common complication of diabetes. 50% of adults with diabetes will develop neuropathy in their lifetime. Diabetic peripheral neuropathy (DPN) is the major form of neuropathy found in 75% of diabetic neuropathy incidences. Pharmacological treatments are recommended for pain management in DPN. Anticonvulsants like pregabalin and gabapentin are the preferred first-line treatment, followed by amitriptyline, duloxetine, and venlafaxine. Topical agents like capsaicin and isosorbide dinitrate are also useful in treating the DPN and may be considered for the second or third-line treatment. Opioids and related drugs are suggested for short-term use during the acute exacerbation of pain. Combination therapy may be beneficial in patients who do not respond to monotherapy. However, currently, there is no compelling evidence to suggest any specific combination of agents. Disease-modifying agents such as alpha-lipoic acid and epalrestat appear to improve the disease state but are not recommended by any guideline. This review discusses the available pharmacological therapy for treating DPN. Also, we highlight the recommendations from different guidelines about the pharmacological treatment of DPN.

Keywords: Diabetic peripheral neuropathy; diabetes; diabetic complication; neuropathic pain; pain; pharmacological treatment.