Patients with diabetic amyotrophy who have a contraindication to oral pharmacotherapy — or who prefer to avoid systemic oral agents — require an alternative strategy for managing neuropathic pain. A distinct, evidence-supported topical treatment pathway applies in this setting.
This protocol addresses diabetic amyotrophy where oral pharmacotherapy cannot be used. In individuals with such contraindications, the treatment approach shifts to topical agents that can be considered as an alternative to systemic oral options.
Topical preparations form the basis of treatment in this scenario. At least one topically applied agent in this class has received regulatory approval for the indication and is supported by clinical study evidence.
Reduction of neuropathic pain in patients with diabetic amyotrophy who cannot use oral pharmacotherapy.
DOI: 10.2337/dc16-2042
In individuals with contraindications to oral pharmacotherapy or who prefer topical treatments, the use of topical capsaicin can be considered.
Capsaicin has received FDA approval for treatment of pain in DPN using an 8% patch, with one high-quality study reported.
One medium-quality study of 0.075% capsaicin cream has been reported.
Lidocaine patches have limited data supporting their use in DPN and are not effective in more widespread distribution of pain (although they may be of use in individuals with nocturnal neuropathic foot pain).
Lidocaine patches cannot be used for more than 12 h in a 24-h period.
Therapeutic strategies (pharmacologic and nonpharmacologic) for the relief of painful DPN and symptoms of autonomic neuropathy can potentially reduce pain and improve quality of life.
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