부산대학교 도서관

Painful Diabetic peripheral neuropathy (painful DPN) is common, is associated with significant reduction in quality of life and poses major treatment challenges to the practising physician. Although poor glucose control and cardiovascular risk factors are proven to contribute to the aetiology of DPN, risk factors specific for painful DPN remain unknown. A number of instruments have been proven to assess the character, intensity and impact of painful DPN on quality of life, activities of daily living and mood. Management of the patient with DPN must be tailored to individual requirements, taking into consideration co-morbidities and other factors. Pharmacological agents with proven efficacy for painful DPN include the tricyclic antidepressants (TCA), the selective serotonin and noradrenaline reuptake inhibitors (SNRIs), anticonvulsants, opiates, membrane stabilizers, the antioxidant alpha-lipoic acid and topical agents including capsaicin. Current first-line therapies for painful DPN include a TCA, the SNRI duloxetine and the anticonvulsants pregabalin and gabapentin: when prescribing any of these agents, other co-morbidities and costs must be taken into account. Second line approaches include use of opiates such as the synthetic opioid tramadol, morphine and oxycodone controlled release. There is a limited literature with regard to combination treatment. In extreme cases of painful DPN unresponsive to pharmacotherapy, occasional use of electrical spinal cord stimulation might be indicated. There are a number of unmet needs in the therapeutic management of painful DPN, and these include the need for randomised controlled trials with active comparators, and the long-term efficacy of agents used as most trials have lasted for less than 6 months. Finally, there is a need for appropriately designed studies to investigate non-pharmacological approaches. Copyright © 2011 John Wiley & Sons, Ltd.