Treatment of pain in diabetic polyneuropathy
DOI:
https://doi.org/10.5281/zenodo.16883501Keywords:
diabetic polyneuropathy, pain, treatmentAbstract
Treatment of painful diabetic polyneuropathy involves a multimodal approach that combines drug therapy and non-drug methods. The first choice of therapy for the treatment of painful diabetic neuropathy are medications from the group of tricyclic antidepressants, anticonvulsants – pregabalin, gabapentin and antidepressants from the group of selective serotonin and norepinephrine reuptake inhibitors – duloxetine, venlafaxine.
Medications of second choice are opioid analgesics, as well as capsaicin cream. In case of an unresponsive pain syndrome, it is appropriate to use a combination of medications belonging to different groups in order to potentiate their effect. The development of new therapies based on molecular and genetic research represents a promising direction for more effective control of neuropathic pain and improvement of patients’ quality of life.
Attempts to phenotype pain will make it possible to search for specific individual treatment for the relevant phenotypic variant. Claims for a possible role of vitamin D deficiency in patients with painful diabetic polyneuropathy show promising data. In the future, level testing could be introduced routinely and supplement the treatment algorithm. An alternative method for influencing drug-resistant pain is repetitive transcranial magnetic stimulation (rTMS). There is a lack of standardization of the parameters and the required number of sessions to perform rTMS in patients with painful diabetic polyneuropathy.
References
Миланов, И., Миланова, А. Лечение и невромодулация с ботулинов токсин. Медицина и физкултура, София, 2017, 128-129. [Milanov, I., Milanova, A. Lechenie i nevromodulatsia s botulinov toksin. Meditsina i fizkultura, Sofia, 2017, 128-129.]
Миланов, И. Национален консенсус за диагностика и лечение на неврологично обусловените болки. Cephalgia, 2023, 25, Suppl. 1, 58-61. [National Consensus on Diagnosis and Treatment of Pain from Neurological Disorders: 2023”. Cephalgia, vol. 25, no. S1, Jan. 2023, pp. 8-66, ] https://glavobolie.org/journal/index.php/ce/issue/view/46
Alam, U., Sloan, G., Tesfaye, S. Treating Pain in Diabetic Neuropathy: Current and Developmental Drugs. Drugs, 2020, 80, 363–384.
Attal, N., Cruccu, G., Baron, R., Haanpää, M., Hansson, P., Jensen, T.S., Nurmikko, T. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur. J. Neurol., 2010, 17, 1113-e88.
Attal, N., Poindessous-Jazat, F., De Chauvigny, E., Quesada, C., Mhalla, A., Ayache, S.S., Fermanian, C., Nizard, J., Peyron, R., Lefaucheur, J.-P., Bouhassira, D. Repetitive transcranial magnetic stimulation for neuropathic pain: a randomized multicentre sham-controlled trial. Brain, 2021, 144, 3328–3339.
Backonja, M., Beydoun, A., Edwards, K.R., Schwartz, S.L., Fonseca, V., Hes, M., LaMoreaux, L., Garofalo, E. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial. JAMA, 1998, 280, 1831–1836.
Baillie, J.K., Power, I. Morphine, gabapentin, or their combination for neuropathic pain. N. Engl. J. Med., 2005, 352, 2650–2651; author reply 2650-2651.
Bansal, D., Bhansali, A., Hota, D., Chakrabarti, A., Dutta, P. Amitriptyline vs. pregabalin in painful diabetic neuropathy: a randomized double blind clinical trial. Diabet Med., 2009, 26, 1019–1026.
Baron, R., Maier, C., Attal, N., Binder, A., Bouhassira, D., Cruccu, G., Finnerup, N.B., Haanpää, M., Hansson, P., Hüllemann, P., Jensen, T.S., Freynhagen, R., Kennedy, J.D., Magerl, W., Mainka, T., Reimer, M., Rice, A.S.C., Segerdahl, M., Serra, J., Sindrup, S., Sommer, C., Tölle, T., Vollert, J., Treede, R.-D., German Neuropathic Pain Research Network (DFNS), and the EUROPAIN, and NEUROPAIN consortia. Peripheral neuropathic pain: a mechanism-related organizing principle based on sensory profiles. Pain, 2017, 158, 261–272.
Binder, A., Baron, R. Utility of transcutaneous electrical nerve stimulation in neurologic pain disorders. Neurology, 2010, 74, 104–105.
Bosi, E., Conti, M., Vermigli, C., Cazzetta, G., Peretti, E., Cordoni, M.C., Galimberti, G., Scionti, L. Effectiveness of frequency-modulated electromagnetic neural stimulation in the treatment of painful diabetic neuropathy. Diabetologia, 2005, 48, 817–823.
Bouhassira, D., Attal, N. Emerging therapies for neuropathic pain: new molecules or new indications for old treatments? Pain, 2018, 159, 576–582.
Bramson, C., Herrmann, D.N., Carey, W., Keller, D., Brown, M.T., West, C.R., Verburg, K.M., Dyck, P.J. Exploring the role of tanezumab as a novel treatment for the relief of neuropathic pain. Pain Med., 2015, 16, 1163–1176.
Campbell, C.M., Kipnes, M.S., Stouch, B.C., Brady, K.L., Kelly, M., Schmidt, W.K., Petersen, K.L., Rowbotham, M.C., Campbell, J.N. Randomized control trial of topical clonidine for treatment of painful diabetic neuropathy. Pain, 2012, 153, 1815–1823.
de Greef, B.T.A., Hoeijmakers, J.G.J., Geerts, M., Oakes, M., Church, T.J.E., Waxman, S.G., Dib-Hajj, S.D., Faber, C.G., Merkies, I.S.J. Lacosamide in patients with Nav1.7 mutationsrelated small fibre neuropathy: a randomized controlled trial. Brain, 2019, 142, 263–275.
Freeman, R. New and developing drugs for the treatment of neuropathic pain in diabetes. Curr Diab Rep, 2013, 13, 500–508.
Freeman, R., Durso-Decruz, E., Emir, B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomized, controlled trials across a range of doses. Diabetes Care, 2008, 31, 1448–1454.
Galan, V., Scowcroft, J., Chang, P., Li, S., Staats, P., Rotte, A., Subbaroyan, J. 10-kHz spinal cord stimulation treatment for painful diabetic neuropathy: results from post-hoc analysis of the SENZA-PPN study. Pain Manag., 2020, 10, 291–300.
Goldstein, D.J., Lu, Y., Detke, M.J., Lee, T.C., Iyengar, S. Duloxetine vs. placebo in patients with painful diabetic neuropathy. Pain, 2005, 116, 109–118.
Hanna, M., O’Brien, C., Wilson, M.C. Prolonged-release oxycodone enhances the effects of existing gabapentin therapy in painful diabetic neuropathy patients. Eur. J. Pain, 2008, 12, 804–813.
Harati, Y., Gooch, C., Swenson, M., Edelman, S., Greene, D., Raskin, P., Donofrio, P., Cornblath, D., Sachdeo, R., Siu, C.O., Kamin, M. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology, 1998, 50, 1842–1846.
Hary, V., Schitter, S., Martinez, V. Efficacy and safety of botulinum A toxin for the treatment of chronic peripheral neuropathic pain: A systematic review of randomized controlled trials and metaanalysis. Eur. J. Pain, 2022, 26, 980–990.
Jann, S., Fazio, R., Cocito, D., Toscano, A., Schenone, A., Marfia, G.A., Antonini, G., De Toni Franceschini, L., Mazzeo, A., Grandis, M., Velardo, D., Mataluni, G., Peci, E. High-dose intravenous immunoglobulin is effective in painful diabetic polyneuropathy resistant to conventional treatments. Results of a double-blind, randomized, placebo-controlled, multicenter trial. Pain Med., 2020, 21, 576–585.
Jensen, T.S., Karlsson, P., Gylfadottir, S.S., Andersen, S.T., Bennett, D.L., Tankisi, H., Finnerup, N.B., Terkelsen, A.J., Khan, K., Themistocleous, A.C., Kristensen, A.G., Itani, M., Sindrup, S.H., Andersen, H., Charles, M., Feldman, E.L., Callaghan, B.C. Painful and non-painful diabetic neuropathy, diagnostic challenges and implications for future management. Brain, 2021, 144, 1632–1645.
Jin, D., Xu, Y., Geng, D., Yan, T. Effect of transcutaneous electrical nerve stimulation on symptomatic diabetic peripheral neuropathy: a meta-analysis of randomized controlled trials. Diabetes Res. Clin. Pract., 2010, 89, 10–15.
Kaur, H., Hota, D., Bhansali, A., Dutta, P., Bansal, D., Chakrabarti, A. A comparative evaluation of amitriptyline and duloxetine in painful diabetic neuropathy: a randomized, doubleblind, cross-over clinical trial. Diabetes Care, 2011, 34, 818–822.
Kochar, D.K., Jain, N., Agarwal, R.P., Srivastava, T., Agarwal, P., Gupta, S. Sodium valproate in the management of painful neuropathy in type 2 diabetes – a randomized placebocontrolled study. Acta Neurol. Scand., 2002, 106, 248–252.
Kulkantrakorn, K., Chomjit, A., Sithinamsuwan, P., Tharavanij, T., Suwankanoknark, J., Napunnaphat, P. 0.075% capsaicin lotion for the treatment of painful diabetic neuropathy: A randomized, double-blind, crossover, placebo-controlled trial. J. Clin. Neurosci., 2019, 62, 174–179.
Kulkantrakorn, K., Lorsuwansiri, C., Meesawatsom, P. 0.025% capsaicin gel for the treatment of painful diabetic neuropathy: a randomized, double-blind, crossover, placebo-controlled trial. Pain Pract., 2013, 13, 497–503.
Lefaucheur, J.-P., Aleman, A., Baeken, C., Benninger, D.H., Brunelin, J., Di Lazzaro, V., Filipović, S.R., Grefkes, C., Hasan, A., Hummel, F.C., Jääskeläinen, S.K., Langguth, B., Leocani, L., Londero, A., Nardone, R., Nguyen, J.-P., Nyffeler, T., Oliveira-Maia, A.J., Oliviero, A., Padberg, F., Palm, U., Paulus, W., Poulet, E., Quartarone, A., Rachid, F., Rektorová, I., Rossi, S., Sahlsten, H., Schecklmann, M., Szekely, D., Ziemann, U.Evidence-based guidelines on the therapeutic use of repetitive transcranial magnetic stimulation (rTMS): An update (2014–2018). Clinical Neurophysiology, 2020, 131, 474–528.
Majdinasab, N., Kaveyani, H., Azizi, M. A comparative doubleblind randomized study on the effectiveness of Duloxetine and Gabapentin on painful diabetic peripheral polyneuropathy. Drug Des. Devel. Ther., 2019, 13, 1985–1992.
Mori, N., Hosomi, K., Nishi, A., Miyake, A., Yamada, T., Matsugi, A., Jono, Y., Lim, C., Khoo, H.M., Tani, N., Oshino, S., Saitoh, Y., Kishima, H. Repetitive transcranial magnetic stimulation focusing on patients with neuropathic pain in the upper limb: a randomized sham-controlled parallel trial. Sci. Rep., 2024, 14, 11811.
Mori, N., Hosomi, K., Nishi, A., Oshino, S., Kishima, H., Saitoh, Y. Analgesic effects of repetitive transcranial magnetic stimulation at different stimulus parameters for neuropathic pain: A randomized study. Neuromodulation, 2022, 25, 520–527.
Naik, A., Bah, M., Govande, M., Palsgaard, P., Dharnipragada, R., Shaffer, A., Air, E.L., Cramer, S.W., Croarkin, P.E., Arnold, P.M. Optimal frequency in repetitive transcranial magnetic stimulation for the management of chronic pain: A network metaanalysis of randomized controlled trials. World Neurosurgery, 2024, 184, 53–64.
Onesti, E., Gabriele, M., Cambieri, C., Ceccanti, M., Raccah, R., Di Stefano, G., Biasiotta, A., Truini, A., Zangen, A., Inghilleri, M. H-coil repetitive transcranial magnetic stimulation for pain relief in patients with diabetic neuropathy. Eur. J. Pain, 2013, 17, 1347–1356.
Otto, M., Bach, F.W., Jensen, T.S., Sindrup, S.H. Valproic acid has no effect on pain in polyneuropathy: a randomized, controlled trial. Neurology, 2004, 62, 285–288.
Oyibo, S.O., Breislin, K., Boulton, A.J.M. Electrical stimulation therapy through stocking electrodes for painful diabetic neuropathy: a double blind, controlled crossover study. Diabet Med., 2004, 21, 940–944.
Pafili, K., Papanas, N. Considerations for single- versus multiple-drug pharmacotherapy in the management of painful diabetic neuropathy. Expert Opin. Pharmacother., 2021, 22, 2267–2280.
Putz, Z., Tordai, D., Hajdú, N., Vági, O.E., Kempler, M., Békeffy, M., Körei, A.E., Istenes, I., Horváth, V., Stoian, A.P., Rizzo, M., Papanas, N., Kempler, P. Vitamin D in the Prevention and Treatment of Diabetic Neuropathy. Clin. Ther., 2022, 44, 813–823.
Rastogi, A., Jude, E.B. Novel treatment modalities for painful diabetic neuropathy. Diabetes Metab. Syndr., 2021, 15, 287–293.
Rosenstock, J., Tuchman, M., LaMoreaux, L., Sharma, U. Pregabalin for the treatment of painful diabetic peripheral neuropathy: a double-blind, placebo-controlled trial. Pain, 2004, 110, 628–638.
Rowbotham, M.C., Goli, V., Kunz, N.R., Lei, D. Venlafaxine extended release in the treatment of painful diabetic neuropathy: a double-blind, placebo-controlled study. Pain, 2004, 110, 697–706.
Shillo, P., Selvarajah, D., Greig, M., Gandhi, R., Rao, G., Wilkinson, I.D., Anand, P., Tesfaye, S. Reduced vitamin D levels in painful diabetic peripheral neuropathy. Diabet Med., 2019, 36, 44–51.
Simpson, D.A. Gabapentin and venlafaxine for the treatment of painful diabetic neuropathy. J. Clin. Neuromuscul Dis., 2001, 3, 53–62.
Simpson, D.M., Robinson-Papp, J., Van, J., Stoker, M., Jacobs, H., Snijder, R.J., Schregardus, D.S., Long, S.K., Lambourg, B., Katz, N. Capsaicin 8% patch in painful diabetic peripheral neuropathy: A randomized, double-blind, placebo-controlled study. J. Pain, 2017, 18, 42–53.
Sindrup, S.H., Otto, M., Finnerup, N.B., Jensen, T.S. Antidepressants in the treatment of neuropathic pain. Basic Clin. Pharmacol. Toxicol., 2005, 96, 399–409.
Soderstrom, L.H., Johnson, S.P., Diaz, V.A., Mainous, A.G. Association between vitamin D and diabetic neuropathy in a nationally representative sample: results from 2001-2004 NHANES. Diabet Med., 2012, 29, 50–55.
Staudt, M.D., Prabhala, T., Sheldon, B.L., Quaranta, N., Zakher, M., Bhullar, R., Pilitsis, J.G., Argoff, C.E. Current Strategies for the Management of Painful Diabetic Neuropathy. J. Diabetes Sci. Technol., 2022, 16, 341–352.
Strand, N.H., Burkey, A.R. Neuromodulation in the treatment of painful diabetic neuropathy: A review of evidence for spinal cord stimulation. J. Diabetes Sci. Technol., 2022, 16, 332–340.
Taheri, M., Sedaghat, M., Solhpour, A., Rostami, P., Safarpour Lima, B. The Effect of Intradermal Botulinum Toxin a injections on painful diabetic polyneuropathy. Diabetes Metab. Syndr., 2020, 14, 1823–1828.
Tesfaye, S., Wilhelm, S., Lledo, A., Schacht, A., Tölle, T., Bouhassira, D., Cruccu, G., Skljarevski, V., Freynhagen, R. Duloxetine and pregabalin: high-dose monotherapy or their combination? The “COMBO-DN study”- a multinational, randomized, double-blind, parallel-group study in patients with diabetic peripheral neuropathic pain. Pain, 2013, 154, 2616–2625.
Tsai, Y.-Y., Wu, W.-T., Han, D.-S., Mezian, K., Ricci, V., Özçakar, L., Hsu, P.-C., Chang, K.-V. Application of repetitive transcranial magnetic stimulation in neuropathic pain: A narrative review. Life (Basel), 2023, 13, 258.
Vinik, A. CLINICAL REVIEW: Use of antiepileptic drugs in the treatment of chronic painful diabetic neuropathy. J. Clin. Endocrinol. Metab., 2005, 90, 4936–4945.
Wang, C., Zhang, Q., Wang, R., Xu, L. Botulinum toxin type A for diabetic peripheral neuropathy pain: A systematic review and meta-analysis. J. Pain Res., 2021, 14, 3855–3863.
Watson, C.P.N., Moulin, D., Watt-Watson, J., Gordon, A., Eisenhoffer, J. Controlled-release oxycodone relieves neuropathic pain: a randomized controlled trial in painful diabetic neuropathy. Pain, 2003, 105, 71–78.
Yang, H., Sloan, G., Ye, Y., Wang, S., Duan, B., Tesfaye, S., Gao, L. New perspective in diabetic neuropathy: From the periphery to the brain, a call for early detection, and precision medicine. Front. Endocrinol. (Lausanne), 2019, 10, 929.
Yuan, R.Y., Sheu, J.J., Yu, J.M., Chen, W.T., Tseng, I.J., Chang, H.H., Hu, C.J. Botulinum toxin for diabetic neuropathic pain: a randomized double-blind crossover trial. Neurology, 2009, 72, 1473–1478.
Zeng, H., Pacheco-Barrios, K., Cao, Y., Li, Y., Zhang, J., Yang, C., Fregni, F. Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and metaanalysis. Sci. Rep., 2020, 10, 19184.
