This protocol applies to patients with diabetes who have developed distal symmetric polyneuropathy (DSPN) and are experiencing neuropathic pain. Neuropathic pain may be the first symptom that prompts patients with DSPN to seek medical care and is present in up to 25% of individuals with this condition.
A structured, evidence-based regimen exists for managing neuropathic pain in this setting. When other analgesic treatments have not provided adequate relief, the protocol addresses pain with a specific class of analgesic agents — with guidance on agent selection drawn from multiple large multicenter trials and regulatory approvals.
DOI: 10.2337/dc16-2042
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.
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.
Although add-on therapy with strong opioids may be required in some patients who do not respond to all other combinations, referral to specialized pain clinics is recommended in these cases to avoid risks.
Extended-release tapentadol was approved by the FDA for the treatment of neuropathic pain associated with diabetes based on data from two multicenter randomized withdrawal, placebo-controlled phase 3 trials.
Controlled-release oxycodone improved pain scores in two single-center trials in patients with painful diabetic neuropathy, one of which had a small sample size.
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