From guideline to patient: a review of recent recommendations for pharmacotherapy of painful diabetic neuropathy

J Diabetes Complications. 2015 Jan-Feb;29(1):146-56. doi: 10.1016/j.jdiacomp.2014.08.008. Epub 2014 Aug 28.


Painful diabetic peripheral neuropathy (DPN) is a common complication of diabetes mellitus, affecting, by some estimates, up to one quarter of diabetic patients. Since 2010, no fewer than 5 major international treatment guidelines for painful DPN have been issued, and there are meaningful differences among them. Duloxetine, pregabalin, gabapentin, and tricyclic antidepressants are the mainstays of treatment, but the choice of which class or agent to use in any given patient should be informed by patient characteristics. This review seeks to describe the differences among the recently issued guidelines, to assess the evidence on which they are based, and to offer insight into the most appropriate treatment choices based on patient characteristics.

Keywords: Anticonvulsants; Antidepressants; Opioids; Painful diabetic neuropathy; Pharmacologic therapy; Treatment guidelines.

Publication types

  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Analgesics, Opioid / administration & dosage
  • Anticonvulsants / administration & dosage
  • Antidepressive Agents / administration & dosage
  • Chronic Pain / drug therapy
  • Diabetic Neuropathies / diagnosis
  • Diabetic Neuropathies / drug therapy*
  • Female
  • Humans
  • Male
  • Pain Management / methods*
  • Pain Measurement*
  • Practice Guidelines as Topic*
  • Quality of Life*
  • Randomized Controlled Trials as Topic
  • Severity of Illness Index
  • Treatment Outcome


  • Analgesics, Opioid
  • Anticonvulsants
  • Antidepressive Agents