Painful Diabetic Polyneuropathy

Approximately one in three people with diabetes is affected by diabetic distal symmetric sensorimotor polyneuropathy (DPN), which is responsible for impaired quality of life by presenting with excruciating neuropathic pain and with painless neuropathic ulcers. The prevalence of painful DPN is 13 to 26%. Diagnosis of DPN should be verified using standardized scores for neuropathic symptoms and deficits and and its course should be monitored. Treatment is based on four cornerstones: intensive diabetes therapy and multifactorial risk intervention; treatment based on pathogenetic mechanisms; symptomatic treatment; and avoidance of risk factors and complications. Pain treatment includes administration of antidepressants such as duloxetine and amitriptyline, calcium channel alpha 2 delta modulators such as pregabalin and opioids as drugs of second choice or for combination therapy. Non-pharmacological treatments always require consideration. Each initiation of treatment requires a thorough estimate of the risk-to-benefit relationship aimed at long-term maintenance of the patients' quality of life.