• 1

    American Diabetes Association: Diabetic statistics. Available at: http://www.diabetes.org/utils/printthispage.jsp?PageID=STATISTICS_233181. Accessed January 30. ,2006. .

    • PubMed
    • Export Citation
  • 2

    Backonja M: Managing painful diabetic neuropathy. .Hosp Pract 34::79. ,1999. .

  • 3

    Diabetes Control and Complications Trial Research Group: The effect of intensive treatment of diabetes on the development of long-term complications in insulin-dependent diabetes mellitus. .N Engl J Med 329::977. ,1993. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 4

    UK Prospective Diabetes Study Group: Intensive blood-glucose control with sulphonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes. .Lancet 352::837. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 5

    Serra J: Overview of neuropathic pain syndromes. .Acta Neurol Scand Suppl 173::7. ,1999. .

  • 6

    Attal N, Bouhassira D: Mechanisms of pain in peripheral neuropathy. .Acta Neurol Scand Suppl 173::12. ,1999. .

  • 7

    Duby JJ, Campbell RK, Setter SM, et al: Diabetic neuropathy: an intensive review. .Am J Health Syst Pharm 61::160. ,2004. .

  • 8

    Gianni C, Dyck PJ: Basement membrane thickening and pericyte degeneration precede development of diabetic polyneuropathy and are associated with its severity. .Ann Neurol 37::498. ,1995. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 9

    Britland ST, Young RJ, Sharma AK, et al: Relationship of endoneurial capillary abnormalities to type and severity of diabetic neuropathy. .Diabetes 39::909. ,1990. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 10

    Timperley WR, Ward JD, Preston FE, et al: Clinical and histological studies in diabetic neuropathy. .Diabetologia 12::237. ,1977. .

  • 11

    Koltzenburg M, Lundberg LER, Torebjork HE: Dynamic and static components of mechanical hyperalgesia in human hairy skin. .Pain 51::207. ,1992. .

  • 12

    LaMotte CC, Shain CN, Simone DA, et al: Neurogenic hyperalgesia: psychophysical studies of underlying mechanisms. .J Neurophysiol 66::190. ,1991. .

  • 13

    LaMotte RH, Lundberg LE, Torebjork HE: Pain hyperalgesia and activity in nociceptive C units in humans after intradermal injection of capsaicin. .J Physiol 448::749. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 14

    Cameron NE, Eaton SE, Tesfaye S: Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. .Diabetologia 44::1973. ,2001. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 15

    Sheetz MJ, King GL: Molecular understanding of hyperglycemia’s adverse effects for diabetic complications. .JAMA 288::2579. ,2002. .

  • 16

    Baynes JW, Thorpe SR: Role of oxidative stress in diabetic complications: a new perspective on an old paradigm. .Diabetes 48::1. ,1999. .

  • 17

    Vinik A: Clinical review: use of antiepileptic drugs in the treatment of chronic painful diabetic neuropathy. .J Clin Endocrinol Metab 90::4936. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 18

    Gimbel JS, Richards P, Portenoy RK: Controlled-release oxycodone for pain in diabetic neuropathy. .Neurology 60::927. ,2003. .

  • 19

    Watson CP, Moulin D, Watt-Watson J, et al: Controlled release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. .Pain 105::71. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 20

    Mendell JR, Sahenk Z: Painful sensory neuropathy. .N Engl J Med 348::1243. ,2003. .

  • 21

    Berdine HJ: Neuropathic pain: diagnosis, treatment and the pharmacist’s role in patient care. Available at: https://secure.pharmacytimes.com/lessons/200509-02.asp. Accessed December 4. ,2005. .

    • PubMed
    • Export Citation
  • 22

    Goldstein DJ, Lu Y, Detke MJ, et al: Duloxetine vs placebo in patients with painful diabetic neuropathy. .Pain 116::102. ,2005. .

  • 23

    Westanmo AD, Gayken J, Haight R: Duloxetine: a balanced and selective norepinephrine- and serotonin-reuptake inhibitor. .Am J Health Syst Pharm 62::2481. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 24

    Duby JJ, Campbell RK: Treatment of painful diabetic neuropathy: a review of the current evidence. Available at: http://www.uspharmacist.com/index.asp?show=article&page=8_1385.htm. Accessed December 4. ,2005. .

    • PubMed
    • Export Citation
  • 25

    Eli Lilly & Co: Cymbalta (duloxetine) product information. Available at: http://pi.lilly.com/us/cymbalta-pi.pdf. Accessed April 10. ,2006. .

    • PubMed
    • Export Citation
  • 26

    Eli Lilly & Co: Cymbalta (duloxetine) safety information. Available at: http://www.cymbalta.com/depression/safety.jsp? Accessed August 27. ,2007. .

    • PubMed
    • Export Citation
  • 27

    Max MB, Culnane M: Amitriptyline relieves diabetic neuropathy pain in patients with normal or depressed mood. .Neurology 37::589. ,1987. .

  • 28

    Max MB, Kishore-Kumar R, Schafer SC, et al: Efficacy of desipramine in painful diabetic neuropathy: a placebo-controlled trial. .Pain 45::3. ,1991. .

  • 29

    Max MB, Lynch SA, Muir J, et al: Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. .N Engl J Med 326::1250. ,1992. .

  • 30

    Kvinesdal B, Molin J, Froland A, et al: Imipramine treatment of painful diabetic neuropathy. .JAMA 251::1727. ,1984. .

  • 31

    Sindrup SH, Bjerre U, Dejgaard A, et al: The selective serotonin reuptake inhibitor citalopram relieves the symptoms of diabetic neuropathy. .Clin Pharmacol Ther 52::547. ,1992. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 32

    Sindrup SH, Gram LF, Brosen K, et al: The selective serotonin reuptake inhibitor paroxetine is effective in the treatment of diabetic neuropathy symptoms. .Pain 42::135. ,1990. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 33

    Sindrup SH, Jensen TS: Efficacy of pharmacological treatments of neuropathic pain and update and effect related to mechanism of drug action. .Pain 83::389. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 34

    Morello CM, Leckband SG, Stoner CP, et al: Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. .Arch Intern Med 159::1931. ,1999. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 35

    Backonja M, Beydoun A, Edwards KR, et al: Gabapentin for symptomatic treatment of painful neuropathy in patients with diabetes: a randomized controlled trial. .JAMA 280::1831. ,1998. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 36

    DeToledo JC, Toledo C, DeCerce J, et al: Changes in body weight with chronic, high dose gabapentin therapy. .Ther Drug Monit 19::394. ,1997. .

  • 37

    Rosenstock J, Tuchman M, LaMoreaux L, et al: Pregabalin for the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled trial. .Pain 110::628. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 38

    Lesser H, Sharma U, LaMoreau L, et al: Pregabalin relieves symptoms of painful diabetic neuropathy: a randomized controlled trial. .Neuropathy 63::2104. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 39

    Richter RW, Portenoy R, Sharma U, et al: Relief of diabetic peripheral neuropathy with pregabalin: a randomised placebo-controlled trial. .J Pain 6::253. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 40

    Medication for Painful DPN Information and Resources at Lyrica.com. Available at: http://www.lyrica.com. Accessed August 27. ,2007. .

    • PubMed
    • Export Citation
  • 41

    Rull J, Quibrera R, Gonzalez-Millian H, et al: Symptomatic treatment of peripheral diabetic neuropathy with carbamazepine: double-blind crossover study. .Diabetologia 5::215. ,1969. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 42

    Dogra S, Beydoun S, Mazzola J, et al: Oxcarbazepine in painful diabetic neuropathy: a randomized, placebo controlled study. .Eur J Pain 9::543. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 43

    Atli A, Dogra S: Zonisamide in the treatment of painful diabetic neuropathy: a randomized, double-blind, placebo-controlled pilot study. .Pain Med 6::225. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 44

    Raskin P, Donofrio PD, Rosenthal NR, et al: Topiramate vs placebo in painful diabetic neuropathy: analgesic and metabolic effects. .Neurology 63::865. ,2004. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 45

    Criner TM, Perdun CS: Dextromethorphan and diabetic neuropathy. .Ann Pharmacother 33::1221. ,1999. .

  • 46

    The Capsaicin Study Group: Treatment of painful diabetic neuropathy with topical capsaicin: a multicenter, double-blind, vehicle-controlled study. .Arch Intern Med 151::2225. ,1991. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 47

    Zeigler D, Lynch SA, Muir J, et al: Transdermal clonidine versus placebo in painful diabetic neuropathy. .Pain 48::403. ,1992. .

  • 48

    Ametov AS, Barinov A, Dyck PJ, et al: The sensory symptoms of diabetic polyneuropathy are improved with alpha lipoic acid. .Diabetes Care 26::770. ,2003. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 49

    Yuen KCJ, Baker NR, Rayman G: Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray. .Diabetes Care 25::1699. ,2002. .

  • 50

    Eichberg J: Protein kinase C changes in diabetes: is the concept relevant to neuropathy. .Int Rev Neurobiol 50::61. ,2002. .

  • 51

    Joy SV, Scates AC, Bearelly S, et al: Ruboxistaurin, a protein kinase C beta inhibitor, as an emerging treatment for diabetes microvascular complications. .Ann Pharmacother 39::1693. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 52

    Vinik AI, Bril V, Kempler P, et al: Treatment of symptomatic diabetic peripheral neuropathy with the protein kinase C beta-inhibitor ruboxistaurin mesylate during a 1-year, randomized, placebo-controlled, double-blind clinical trial. .Clin Ther 27::1164. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation
  • 53

    Vinik A: The protein kinase C-beta inhibitor, ruboxistaurin, for the treatment of diabetic microvascular complications. .Expert Opin Investig Drugs 14::1547. ,2005. .

    • PubMed
    • Search Google Scholar
    • Export Citation

Painful Diabetic Peripheral Neuropathy

Robert G. Smith Private practice, Shoe String Podiatry, 723 Lucerne Cir, Ormond Beach, FL 32174.

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 DPM, MSc, RPh, CPed

Painful peripheral neuropathy is a common complication of diabetes mellitus that can affect almost every tissue of the body. In the absence of a curative therapy for this disorder, pharmacologic or nonpharmacologic tools, or a combination of both, can be used to provide relief of symptoms. This article reviews medications currently used to manage painful diabetic neuropathy. The pathogenesis of painful diabetic neuropathy is described as a basis for understanding medication selection. The literature describing the pharmacologic properties of medications used to treat painful diabetic neuropathy is also reviewed. Comparisons of medication dosages, frequencies, and adverse effects are offered to help with selection of the most appropriate agent for each individual patient. (J Am Podiatr Med Assoc 97(5): 394–401, 2007)

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