Evidence-based guideline: treatment of painful diabetic neuropathy--report of
the American Association of Neuromuscular and Electrodiagnostic Medicine, the
American Academy of Neurology, and the American Academy of Physical Medicine &
Rehabilitation.
Authors Bril V, England JD, Franklin GM, Backonja M, Cohen JA, Del Toro DR, Feldman EL,
Iverson DJ, Perkins B, Russell JW, Zochodne DW
Submitted By Eva Feldman on 12/10/2012
Status Published
Journal Muscle & nerve
Year 2011
Date Published 6/1/2011
Volume : Pages 43 : 910 - 917
PubMed Reference 21484835
Abstract The objective of this report was to develop a scientifically sound and
clinically relevant evidence-based guideline for the treatment of painful
diabetic neuropathy (PDN). The basic question that was asked was: "What is the
efficacy of a given treatment (pharmacological: anticonvulsants,
antidepressants, opioids, others; non-pharmacological: electrical stimulation,
magnetic field treatment, low-intensity laser treatment, Reiki massage, others)
to reduce pain and improve physical function and quality of life (QOL) in
patients with PDN?" A systematic review of literature from 1960 to August 2008
was performed, and studies were classified according to the American Academy of
Neurology classification of evidence scheme for a therapeutic article.
Recommendations were linked to the strength of the evidence. The results
indicate that pregabalin is established as effective and should be offered for
relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin,
valproate, opioids (morphine sulfate, tramadol, and oxycodone
controlled-release), and capsaicin are probably effective and should be
considered for treatment of PDN (Level B). Other treatments have less robust
evidence, or the evidence is negative. Effective treatments for PDN are
available, but many have side effects that limit their usefulness. Few studies
have sufficient information on their effects on function and QOL.


Investigators with authorship
NameInstitution
Eva FeldmanUniversity of Michigan

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