Distal symmetric polyneuropathy (DSPN) is a frequent complication of diabetes. Neuropathic pain is present in up to 25% of individuals with DSPN and is often the first symptom that brings patients to seek care.
This protocol targets a patient with diabetes who has developed distal symmetric polyneuropathy with clinically significant neuropathic pain — a subset that requires targeted pharmacological intervention beyond glycaemic management alone.
First-line management centres on specific approved pharmacological agents, with the initial choice guided by the patient's comorbidities, socioeconomic context, and potential drug interactions — the full selection criteria and titration algorithm are in the complete protocol.
Target outcome:
At least 30–50% reduction in neuropathic painDOI: 10.2337/dc16-2042
Neuropathic pain may be the first symptom that prompts patients to seek medical care and is present in up to 25% of individuals with DSPN.
Below we summarize the available evidence on the most effective agents for DSPN pain starting with the currently approved drugs and continuing with the other agents based on mechanism of action and strength of evidence.
Consider either pregabalin or duloxetine as the initial approach in the symptomatic treatment for neuropathic pain in diabetes.
Gabapentin may also be used as an effective initial approach, taking into account patients' socioeconomic status, comorbidities, and potential drug interactions.
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