Chapter

Assessment and management of painful diabetic peripheral neuropathy

Solomon Tesfaye

in Diabetic Neuropathy

Published on behalf of Oxford University Press

ISBN: 9780199551064
Published online May 2011 | e-ISBN: 9780199607303 | DOI: http://dx.doi.org/10.1093/med/9780199551064.003.0005

Series: Oxford Diabetes Library

Assessment and management of painful diabetic peripheral neuropathy

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• Painful diabetic peripheral neuropathy (DPN) is common and can be distressing. However, despite this, it continues to be under-diagnosed and under-treated. • The minimum requirements for diagnosis of painful DPN are assessment of symptoms and neurological examination, with shoes and sock removed. Bilateral sensory impairment is almost always present. • Painful diabetic neuropathy is characterized by burning, shooting, or stabbing pain in the extremities. Pain may be spontaneous or evoked. • Optimization of cardiovascular risk factors and improved glycaemic control are important. • First-line therapies for painful DPN are tricyclic antidepressants (TCA), serotonin noradrenaline reuptake inhibitors (SNRIs) (such as duloxetine), or anticonvulsants (such as pregabalin or gabapentin), taking into account patients’ co-morbidities and cost. • Combination therapy may be useful although the evidence base is relatively poor.

Chapter.  4980 words.  Illustrated.

Subjects: Neurology ; Pain Medicine

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