Med. praxi. 2013;10(5):203-206 [Neurol. praxi. 2012;13(1):17-20]

Painful diabetic neuropathy

prof.MUDr.Zdeněk Ambler, DrSc.

Neurologická klinika LF UK a FN, Plzeň

Painful diabetic neuropathy is common and is associated with significant reduction in quality of life. A distal and symmetric peripheral

neuropathy is the most frequent form, and small fiber damage is thought to result in painful symptoms. The much less common though

well recognized are acute painful and atypical neuropathies. Management of the patient with painful neuropathy is difficult, must be tailored

to individual requirements, taking into consideration comorbidities and other factors. Pharmacological management represents the

most important therapeutic option for chronic neuropathic pain. Current first-line agents with proven efficacy for painful neuropathies are

tricyclic antidepressants (amitriptyline, nortriptyline), serotonin-norepinephrine reuptake inhibitors (SNRI – duloxetine and venlafaxine)

and the anticonvulsants pregabalin and gabapentin. Second line approaches include use of opioids, thioctic acid and sodium valproate.

Keywords: neuropathic pain, pharmacotherapy, tricyclic antidepressants, duloxetine, pregabalin

Published: June 1, 2013  Show citation