Diabetic Neuropathy: A Guide to Pain Management

Emily X Zhang¹, Cyrus Yazdi², Rahib K Islam³, Ahmed I Anwar⁴, Alana Alvares-Amado⁵, Horace Townsend⁵, Kaitlyn E Allen³, Elena Plakotaris³, Jon D Hirsch⁶, Ross G Rieger⁶, Varsha Allampalli⁶, Jamal Hasoon⁷, Kazi N Islam⁸, Sahar Shekoohi^#⁹, Alan D Kaye^#¹⁰, Christopher L Robinson^#²

Affiliations

¹ Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
² Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
³ LSU Health Sciences Center New Orleans School of Medicine, 1901 Gravier Street, New Orleans, LA, 70112, USA.
⁴ Department of Psychology, Quinnipiac University, 275 Mt Carmel Ave, Hamden, CT, 06518, USA.
⁵ American University of the Caribbean School of Medicine, 1 University Drive at, Jordan Dr, Cupecoy, Sint Maarten.
⁶ Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
⁷ Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA.
⁸ Agricultural Research Development Program, Central State University, 1400 Brush Row Road, Wilberforce, OH, 45384, USA.
⁹ Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA. sahar.shekoohi@lsuhs.edu.
¹⁰ Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.

^# Contributed equally.

PMID: 38967712
DOI: 10.1007/s11916-024-01293-9

Review

Diabetic Neuropathy: A Guide to Pain Management

Emily X Zhang et al. Curr Pain Headache Rep. 2024 Oct.

. 2024 Oct;28(10):1067-1072.

doi: 10.1007/s11916-024-01293-9. Epub 2024 Jul 5.

Authors

Affiliations

¹ Department of Anesthesia, Critical Care and Pain Medicine, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA.
² Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA.
³ LSU Health Sciences Center New Orleans School of Medicine, 1901 Gravier Street, New Orleans, LA, 70112, USA.
⁴ Department of Psychology, Quinnipiac University, 275 Mt Carmel Ave, Hamden, CT, 06518, USA.
⁵ American University of the Caribbean School of Medicine, 1 University Drive at, Jordan Dr, Cupecoy, Sint Maarten.
⁶ Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.
⁷ Department of Anesthesia and Pain Medicine, UTHealth McGovern Medical School, Houston, TX, USA.
⁸ Agricultural Research Development Program, Central State University, 1400 Brush Row Road, Wilberforce, OH, 45384, USA.
⁹ Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA. sahar.shekoohi@lsuhs.edu.
¹⁰ Departments of Anesthesiology and Pharmacology, Toxicology, and Neurosciences, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, 71103, USA.

^# Contributed equally.

PMID: 38967712
DOI: 10.1007/s11916-024-01293-9

Abstract

Purpose of review: Diabetic neuropathy is a common complication of diabetes mellitus (DM) and can affect up to 50% of DM patients during their lifetime. Patients typically present with numbness, tingling, pain, and loss of sensation in the extremities. Since there is no treatment targeting the underlying mechanism of neuropathy, strategies focus on preventative care and pain management.

Recent findings: Up to 69% of patients with diabetic neuropathy receive pharmacological treatment for neuropathic pain. The United States Food and Drug Administration (FDA) confirmed four drugs for painful diabetic neuropathy (PDN): pregabalin, duloxetine, tapentadol, and the 8% capsaicin patch. Nonpharmacological treatments such as spinal cord stimulation (SCS) and transcutaneous electrical nerve stimulation (TENS) both show promise in reducing pain in DM patients. Despite the high burden associated with PDN, effective management remains challenging. This update covers the background and management of diabetic neuropathy, including its epidemiology, pathogenesis, preventative care, and current therapeutic strategies.

Keywords: Capsaicin; Duloxetine; Painful Diabetic Neuropathy; Pregabalin; Spinal Cord Stimulation; Tapentadol.

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References

1. Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett DL, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5:41. Comprehensive review on diabetic neuropathy. - DOI - PubMed
1. Taylor RS, Lad SP, White JL, Stauss TG, Healey BE, Sacks NC, et al. Health care resource utilization and costs in patients with painful diabetic neuropathy treated with 10 kHz spinal cord stimulation therapy. J Manag Care Spec Pharm. 2023;29:1021–9. Utilization of SCS resulted in lower rates of hospitalization and consequently lower health care costs. - PubMed - PMC
1. Pop-Busui R, Boulton AJM, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic neuropathy: a position statement by the American Diabetes Association. Diabetes Care. 2017;40:136–54. - DOI - PubMed
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1. Hicks CW, Selvin E. Epidemiology of peripheral neuropathy and lower extremity disease in diabetes. Curr Diab Rep. 2019;19:86. - DOI - PubMed - PMC

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Diabetic Neuropathy: A Guide to Pain Management

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Diabetic Neuropathy: A Guide to Pain Management

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