The pathogenesis and management of painful diabetic neuropathy: a review

Diabet Med. 2003 Feb;20(2):88-98. doi: 10.1046/j.1464-5491.2003.00852.x.


Painful diabetic neuropathy has always been a challenging complication of diabetes mellitus. Emerging theories suggest that early dysaesthesia associated with painful neuropathy may act as a marker for the development of the 'at risk' foot, allowing preventative clinical strategies to be undertaken. The mechanisms of neuropathic pain are complex. The authors' intentions are to help members of the diabetes care team better understand and appreciate the diverse symptoms reported by patients. The various treatments available for painful neuropathy are discussed in detail. Robust comparative studies on such treatments are, however, unavailable and the authors have designed a logical approach to management based on best current evidence and their own clinical experience.

Publication types

  • Review

MeSH terms

  • Anti-Arrhythmia Agents / therapeutic use
  • Anticonvulsants / therapeutic use
  • Antidepressive Agents / therapeutic use
  • Blood Glucose / metabolism
  • Capsaicin / therapeutic use
  • Diabetic Foot / prevention & control
  • Diabetic Neuropathies / blood
  • Diabetic Neuropathies / etiology
  • Diabetic Neuropathies / therapy*
  • Humans
  • N-Methylaspartate / antagonists & inhibitors
  • Pain / etiology
  • Pain / prevention & control
  • Selective Serotonin Reuptake Inhibitors / therapeutic use
  • Transcutaneous Electric Nerve Stimulation / methods


  • Anti-Arrhythmia Agents
  • Anticonvulsants
  • Antidepressive Agents
  • Blood Glucose
  • Serotonin Uptake Inhibitors
  • N-Methylaspartate
  • Capsaicin