Evidence-based guideline: Treatment of painful diabetic neuropathy

Neurology®, 05/19/2011

Bril V et al. – Pregabalin is established as effective and should be offered for relief of painful diabetic neuropathy(PDN) (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled–release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B).


  • Systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence was performed.
  • Basic question asked was: “What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low–intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN.


  • Other treatments have less robust evidence or the evidence is negative.
  • Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.

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