Abstract
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.