Multidisciplinary management of painful diabetic peripheral neuropathy: literature review and updated recommendation

Abstract

Summary The management of painful diabetic peripheral neuropathy (DPN) requires a multidisciplinary approach, encompas sing both pharmacological and non-pharmacological treatment strategies. The Mul t idiscipl inar y Panel on Neuropathic Pain has publ ished recommendat ions on the management of painful DPN and provides here an update that emphasises the importance of good glycaemic control for all patients with diabetes, and includes newly published epidemiological studies and clinical evidence for the management of painful DPN. Based on published clinical evidence and international guidelines, first-line agents for DPN include α2δ-ligands, tricyclic antidepressants and selective serotonin-norepinephrine reuptake inhibitors. If a reasonable trial of a first-line agent does not relieve pain effectively, combination therapy with or switching to another first-line agent should be considered. Tramadol can be considered as a second-line treatment option.

摘要 糖尿病性末梢神經病變引起的疼痛，需由不同學科的醫 療團隊以藥物及非藥物方式進行治療。跨學科研究神經 病變性疼痛小組在最近發表治療糖尿病性末梢神經病變 的建議時，強調所有糖尿病患者在控制血糖水平的重要 性，並引述最新處理糖尿病末梢神經病變性疼痛的流行 病學研究和臨床實證。據已發表的臨床實證和國際指 引，治療糖尿病性末梢神經病變的第一線藥物包括α2δ- 配體、三環類抗抑鬱藥和選擇性血清素及正腎上腺素再 吸收抑制劑。當第一線藥物未能有效紓緩痛楚時，可考 慮轉換另一種第一線藥物或同時使用兩種一線藥物；而 曲馬朵 (tramadol) 可作為第二線治療選擇。