Modern treatment modalities for painful distal diabetic neuropathy
Red'kin Yu.A.
M.F. Vladimirskiy Moscow Regional Clinical and Research Institute, Moscow

Currently, individual treatment choice for painful diabetic neuropathy is challenging due to the lack of comparative clinical trials of treatment efficacy with sufficient statistical power and follow-up as well as limited and controversial outcomes of various treatments. Most current guidelines recommend three major treatment approaches to this condition, i.e., diabetes therapy improvement, medications, and non-medical treatment. The paper summarizes major therapeutic algorithms for painful distal diabetic neuropathy, highlights the importance of blood glucose normalizing, and discusses medications for this condition and additional non-medical treatments. Major medications for painful distal diabetic neuropathy are tricyclic antidepressants, serotonin norepinephrine reuptake inhibitors, calcium channel blockers, opioids, B vitamins and alpha lipoic acid. Mechanisms of their action, treatment regimens (therapeutic and maximum tolerated doses, principles of dose titration), adverse side effects, and precautions are discussed.

Key words: diabetes, complications, distal neuropathy, neuropathic pain, treatment approaches to  neuropathic pain.

For citation: Red'kin Yu.A. Modern treatment modalities for painful distal diabetic neuropathy // RMJ. 2017. № 1. P. 14–18.