Neuropathic Pain in Diabetic Amyotrophy Not Controlled by Single-Agent Therapy

Neuropathic pain is a primary management challenge in diabetic amyotrophy. This protocol is for the clinical situation in which first-line, single-agent pharmacologic treatment has been tried and has not achieved adequate pain reduction.

Previous Treatment — Failure Condition

Prior therapy: Initial pharmacologic treatment for neuropathic pain with a single agent from one of the recommended classes — a gabapentinoid, an SNRI, a tricyclic antidepressant, or a sodium channel blocker.

Goal not reached: Reduction of neuropathic pain.

This protocol is the next step when that monotherapy approach did not provide sufficient pain relief.

Treatment Approach

When a single agent is insufficient, the evidence supports moving to a combination approach drawing from the same recommended agent classes — though the specific structure, number of agents involved, and the principles guiding how they are used together are set out in the full protocol.

Clinical Goal

Additional relief of neuropathic pain.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.2337/dc16-2042

For those with severe painful symptoms not responding to a single agent, combination therapy with two to three agents may be effective at much lower doses, and pharmacological and nonpharmacological approaches may also be effective.
Combinations of these medications can provide additional relief of neuropathic pain.
The trial also supported the role of combination therapy in those who did not respond well to monotherapy for the treatment of pain in DPN.

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