Diabetic Neuropathy: A narrative review of pathophysiology, diagnosis, and treatment
Keywords:
Diabetic Neuropathies, Neuralgia, Diabetes Mellitus
Abstract
Diabetic neuropathy occurs in up to 60% of diabetic patients. Diabetic peripheral neuropathy is the most common cause of neuropathy in the world. The pathophysiology of diabetic neuropathy involves peripheral nerve damage due to the accumulation of toxic products derived from hyperglycemia. The central nervous system is subsequently involved through sensitization, decreased function of the inhibitory system, and increased excitability of the facilitative system. The most common symptoms manifest symmetrically, affecting small and large sensory fibers, although atypical forms of presentation have been found. Confirmatory diagnostic tests are reserved for diagnostic doubt, atypical symptoms, or research. The consensus regarding treatment is the prescription of gabapentinoids, tricyclic antidepressants, and serotonin and norepinephrine reuptake inhibitors. These three families are considered the first line.
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References
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10. Sandireddy R, Yerra VG, Areti A, Komirishetty P, Kumar A. Neuroinflammation and Oxidative Stress in Diabetic Neuropathy: Futuristic Strategies Based on These Targets. Int J Endocrinol. 2014; 2014:1-10.doi:10.1155/2014/674987
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13. Tsuda M, Koga K, Chen T, Zhuo M. Neuronal and microglial mechanisms for neuropathic pain in the spinal dorsal horn and anterior cingulate cortex. J Neurochem. 2017;141(4): 486–98.doi:10.1111/jnc.14001
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15. Chen J, Li L, Chen SR, Chen H, Xie JD, Sirrieh RE, et al. The α2δ-1-NMDA Receptor Complex Is Critically Involved in Neuropathic Pain Development and Gabapentin Therapeutic Actions. Cell Rep. 2018; 22(9): 2307–21. doi: 10.1016/j.celrep.2018.02.021
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17. Terkelsen AJ, Karlsson P, Lauria G, Freeman R, Finnerup NB, Jensen TS. The diagnostic challenge of small fibre neuropathy: clinical presentations, evaluations, and causes. Lancet Neurol. 2017;16(11): 934–44. doi:10.1016/S1474-4422(17)30329-0
18. Trouvin AP, Perrot S. New concepts of pain. Best Pract Res Cl Rh. 2019; 33(3):101415. doi: 10.1016/j.berh.2019.04.007
19. Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, et al. The IASP classification of chronic pain for ICD-11. Pain. 2019;160(1): 53–59. doi: 10.1097/j.pain.0000000000001365
20. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1): 136-54.doi:10.2337/dc16-2042
21. Sommer C, Geber C, Young P, Forst R, Birklein F, Schoser B. Polyneuropathies. Dtsch Arztebl Int. 2018;115(6): 83-90.doi:10.3238/arztebl.2018.083
22. Barrell K, Smith AG. Peripheral Neuropathy.Med Clin North Am. 2019;103(2):383-97. doi:10.1016/j.mcna.2018.10.006
23. Bruschi LKM, Rocha DA, Filho ELG, Barboza NMP, Frisanco PAB, Callegaro RM, et al. Diabetes Mellitus and Diabetic Peripheral Neuropathy. J Endocrine Metab Dis. 2017;7(1): 12-21.doi: 10.4236/ojemd.2017.71002
24. Won JC, Park TS. Recent Advances in Diagnostic Strategies for Diabetic Peripheral Neuropathy. Endocrinol Metab. 2016; 31(2): 230-238.doi:10.3803/EnM.2016.31.2.230
25. Pant I, Jha K, Singh R, Kushwaha S, Chaturvedi S. Peripheral neuropathy and the role of nerve biopsy: A revisit. Indian J Pathol Microbiol. 2018; 61(3): 339-44. doi: 10.4103/IJPM.IJPM_402_17
26. Jiang MS, Yuan Y, Gu ZX, Zhuang SL. Corneal confocal microscopy for assessment of diabetic peripheral neuropathy: a meta-analysis. Br J Ophthalmol. 2015; 100(1): 9–14. doi:10.1136/bjophthalmol-2014-306038.
27. National Institute for Health and Care Excellence. Neuropathic pain in adults: pharmacological management in non-specialist settings. NICE Clinical Guidelines [Internet]. 22 septiembre 2020 [citado el 2 octubre 2023]; 173:[1-37p.]. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK552848/. Acceso gratuito.
28. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–88.doi:10.1111/j.1468-1331.2010.02999.x
29. Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract. 2022;28(10):923-1049. doi:10.1016/j.eprac.2022.08.002
30. Price R, Smith D, Franklin G, Gronseth G, Pignone M, David WS, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98(1):31-43. doi:10.1212/WNL.0000000000013038
31. Diabetes Canada Clinical Practice Guidelines Expert Committee; Bril V, Breiner A, Perkins BA, Zochodne D. Neuropathy. Can J Diabetes. 2018;42 Suppl 1:217-21. doi:10.1016/j.jcjd.2017.10.028
32. Alam U, Sloan G, Tesfaye S. Treating Pain in Diabetic Neuropathy: Current and Developmental Drugs. Drugs. 2020;80(4):363-84.doi:10.1007/s40265-020-01259-2
33. Ardeleanu V, Toma A, Pafili K, Papanas N, Motofei I, Diaconu CC, et al. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina. 2020; 56(1):25.doi:10.3390/medicina56010025
34. Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD007938. doi:10.1002/14651858.CD007938.pub4
35. Raskin P, Huffman C, Toth C, Asmus MJ, Messig M, Sanchez RJ, et al. Pregabalin in Patients With Inadequately Treated Painful Diabetic Peripheral Neuropathy. Clin J Pain. 2014;30(5):379-90.doi:10.1097/AJP.0b013e31829ea1a1
36. Mu Y, Liu X, Li Q, Chen K, Liu Y, Lv X, et al. Efficacy and safety of pregabalin for painful diabetic peripheral neuropathy in a population of Chinese patients: A randomized placebo-controlled trial. J Diabetes. 2018;10(3): 256–65. doi:10.1111/1753-0407.12585
37. Derry S, Bell RF, Straube S, Wiffen PJ, Aldington D, Moore RA. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev. 2019;1(1):CD007076. doi:10.1002/14651858.CD007076.pub3
38. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;(7):CD008242. doi:10.1002/14651858.CD008242.pub3
39. Brunton S, Wang F, Edwards SB, Crucitti AS, Ossanna MJ, Walker DJ, et al. Profile of adverse events with duloxetine treatment: a pooled analysis of placebo-controlled studies. Drug Saf.2010;33(5):393–407.doi:10.2165/11319200-000000000-00000
40. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;(1):CD007115. doi:10.1002/14651858.CD007115.pub3
41. Tesfaye S, Wilhelm S, Lledo A, Schacht A, Tölle T, Bouhassira D, et al. 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(12):2616-2625. doi:10.1016/j.pain.2013.05.043
42. Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Julious S, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022;400(10353):680-90. doi:10.1016/S0140-6736(22)01472-6
43. Harati Y, Gooch C, Swenson M, Edelman S, Greene D, Raskin P, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998;50(6):1842-46. doi:10.1212/WNL.50.6.1842
44. Vinik AI, Shapiro DY, Rauschkolb C, Lange B, Karcher K, Pennett D, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37(8):2302-09. doi:10.2337/dc13-2291
45. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013;(8): CD006146. doi:10.1002/14651858.CD006146.pub2
46. 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(6):497–503.doi:10.1111/papr.12013
47. Goodwin B, Chiplunkar M, Salerno R, Coombs K, Sannoh U, Shah V, et al. Topical capsaicin for the management of painful diabetic neuropathy: a narrative systematic review. Pain Manag. 2023. doi:10.2217/pmt-2023-0006
48. Slangen R, Schaper NC, Faber CG, Joosten EA, Dirksen CD, van Dongen RT, et al. Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: a prospective two-center randomized controlled trial. Diabetes Care. 2014;37(11):3016-24. doi:10.2337/dc14-0684
49. van Beek M, Geurts JW, Slangen R, Schaper NC, Faber CG, Joosten EA, et al. Severity of Neuropathy Is Associated With Long-term Spinal Cord Stimulation Outcome in Painful Diabetic Peripheral Neuropathy: Five-Year Follow-up of a Prospective Two-Center Clinical Trial. Diabetes Care. 2018;41(1):32-38.doi:10.2337/dc17-0983
50. Petersen EA, Stauss TG, Scowcroft JA, Brooks ES, White JL, Sills SM et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial. JAMA Neurol. 2021; 78(6):687-98. doi:10.1001/jamaneurol.2021.0538
51. Petersen EA, Stauss TG, Scowcroft JA, Brooks ES, White JL, Sills SM, et al. Durability of High-Frequency 10-kHz Spinal Cord Stimulation for Patients with Painful Diabetic Neuropathy Refractory to Conventional Treatments: 12-Month Results From a Randomized Controlled Trial. Diabetes Care. 2022;45(1):3-6. doi:10.2337/dc21-1813
2. Iqbal Z, Azmi S, Yadav R, Ferdousi M, Kumar M, Cuthbertson DJ, et al. Diabetic Peripheral Neuropathy: Epidemiology, Diagnosis, and Pharmacotherapy. Clin Ther. 2018;40(6): 828-49.doi: 10.1016/j.clinthera.2018.04.001
3. Callaghan BC, Gallagher G, Fridman V, Feldman EL. Diabetic neuropathy: what does the future hold? Diabetologia 2020;63(5):891-97.doi:10.1007/s00125-020-05085-9
4. Sun J, Wang Y, Zhang X, Zhu S, He H. Prevalence of peripheral neuropathy in patients with diabetes: A systematic review and meta-analysis. Prim Care Diab. 2020;14(5):435-44. doi: 10.1016/j.pcd.2019.12.005
5. Rosenberger DC, Blechschmidt V, Timmerman H, Wolff A, Treede RD. Challenges of neuropathic pain: focus on diabetic neuropathy. J Neural Transm. 2020;127(4):589-624. doi:10.1007/s00702-020-02145-7
6. Callaghan BC, Little AA, Feldman EL, Hughes RA. Enhanced glucose control for preventing and treating diabetic neuropathy. Cochrane Database Syst Rev. 2012;13(6):CD007543. doi: 10.1002/14651858.CD007543.pub2
7. Pantalone KM, Misra-Hebert AD, Hobbs TM, Wells BJ, Kong SX, Chagin K, et al. Effect of glycemic control on the Diabetes Complications Severity Index score and development of complications in people with newly diagnosed type 2 diabetes. J Diabetes. 2018;10(3):192–9. doi:10.1111/1753-0407.12613
8. Callaghan BC, Gao L, Li Y, Zhou X, Reynolds E, Banerjee M, et al. Diabetes and obesity are the main metabolic drivers of peripheral neuropathy. Ann Clin Trans Neurol. 2018;5(4): 397–405. doi:10.1002/acn3.531
9. Grisold A, Callaghan BC, Feldman EL. Mediators of diabetic neuropathy: is hyperglycemia the only culprit? Curr Opin Endocrinol Diabetes Obes. 2017;24(2):103-11. doi:10.1097/med.0000000000000320
10. Sandireddy R, Yerra VG, Areti A, Komirishetty P, Kumar A. Neuroinflammation and Oxidative Stress in Diabetic Neuropathy: Futuristic Strategies Based on These Targets. Int J Endocrinol. 2014; 2014:1-10.doi:10.1155/2014/674987
11. Yagihashi S, Mizukami H, Sugimoto K. Mechanism of diabetic neuropathy: Where are we now and where to go? J Diabetes Invest. 2011;2(1):18–32. doi:10.1111/j.2040-1124.2010.00070.x
12. Colloca L, Ludman T, Bouhassira D, Baron R, Dickenson AH, Yarnitsky D, et al. Neuropathic pain. Nat Rev Dis Primers. 2017; 3:17002.doi:10.1038/nrdp.2017.2
13. Tsuda M, Koga K, Chen T, Zhuo M. Neuronal and microglial mechanisms for neuropathic pain in the spinal dorsal horn and anterior cingulate cortex. J Neurochem. 2017;141(4): 486–98.doi:10.1111/jnc.14001
14. van den Broeke EN. Central sensitization and pain hypersensitivity: Some critical considerations. F1000Res. 2018; 7:1325.doi:10.12688/f1000research.15956.2
15. Chen J, Li L, Chen SR, Chen H, Xie JD, Sirrieh RE, et al. The α2δ-1-NMDA Receptor Complex Is Critically Involved in Neuropathic Pain Development and Gabapentin Therapeutic Actions. Cell Rep. 2018; 22(9): 2307–21. doi: 10.1016/j.celrep.2018.02.021
16. Feldman EL, Callaghan BC, Pop-Busui R, Zochodne DW, Wright DE, Bennett D, et al. Diabetic neuropathy. Nat Rev Dis Primers. 2019;5(1): 41. doi:10.1038/s41572-019-0092-1
17. Terkelsen AJ, Karlsson P, Lauria G, Freeman R, Finnerup NB, Jensen TS. The diagnostic challenge of small fibre neuropathy: clinical presentations, evaluations, and causes. Lancet Neurol. 2017;16(11): 934–44. doi:10.1016/S1474-4422(17)30329-0
18. Trouvin AP, Perrot S. New concepts of pain. Best Pract Res Cl Rh. 2019; 33(3):101415. doi: 10.1016/j.berh.2019.04.007
19. Scholz J, Finnerup NB, Attal N, Aziz Q, Baron R, Bennett MI, et al. The IASP classification of chronic pain for ICD-11. Pain. 2019;160(1): 53–59. doi: 10.1097/j.pain.0000000000001365
20. Pop-Busui R, Boulton AJ, Feldman EL, Bril V, Freeman R, Malik RA, et al. Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care. 2017;40(1): 136-54.doi:10.2337/dc16-2042
21. Sommer C, Geber C, Young P, Forst R, Birklein F, Schoser B. Polyneuropathies. Dtsch Arztebl Int. 2018;115(6): 83-90.doi:10.3238/arztebl.2018.083
22. Barrell K, Smith AG. Peripheral Neuropathy.Med Clin North Am. 2019;103(2):383-97. doi:10.1016/j.mcna.2018.10.006
23. Bruschi LKM, Rocha DA, Filho ELG, Barboza NMP, Frisanco PAB, Callegaro RM, et al. Diabetes Mellitus and Diabetic Peripheral Neuropathy. J Endocrine Metab Dis. 2017;7(1): 12-21.doi: 10.4236/ojemd.2017.71002
24. Won JC, Park TS. Recent Advances in Diagnostic Strategies for Diabetic Peripheral Neuropathy. Endocrinol Metab. 2016; 31(2): 230-238.doi:10.3803/EnM.2016.31.2.230
25. Pant I, Jha K, Singh R, Kushwaha S, Chaturvedi S. Peripheral neuropathy and the role of nerve biopsy: A revisit. Indian J Pathol Microbiol. 2018; 61(3): 339-44. doi: 10.4103/IJPM.IJPM_402_17
26. Jiang MS, Yuan Y, Gu ZX, Zhuang SL. Corneal confocal microscopy for assessment of diabetic peripheral neuropathy: a meta-analysis. Br J Ophthalmol. 2015; 100(1): 9–14. doi:10.1136/bjophthalmol-2014-306038.
27. National Institute for Health and Care Excellence. Neuropathic pain in adults: pharmacological management in non-specialist settings. NICE Clinical Guidelines [Internet]. 22 septiembre 2020 [citado el 2 octubre 2023]; 173:[1-37p.]. Disponible en: https://www.ncbi.nlm.nih.gov/books/NBK552848/. Acceso gratuito.
28. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–88.doi:10.1111/j.1468-1331.2010.02999.x
29. Blonde L, Umpierrez GE, Reddy SS, McGill JB, Berga SL, Bush M, et al. American Association of Clinical Endocrinology Clinical Practice Guideline: Developing a Diabetes Mellitus Comprehensive Care Plan-2022 Update. Endocr Pract. 2022;28(10):923-1049. doi:10.1016/j.eprac.2022.08.002
30. Price R, Smith D, Franklin G, Gronseth G, Pignone M, David WS, et al. Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary: Report of the AAN Guideline Subcommittee. Neurology. 2022;98(1):31-43. doi:10.1212/WNL.0000000000013038
31. Diabetes Canada Clinical Practice Guidelines Expert Committee; Bril V, Breiner A, Perkins BA, Zochodne D. Neuropathy. Can J Diabetes. 2018;42 Suppl 1:217-21. doi:10.1016/j.jcjd.2017.10.028
32. Alam U, Sloan G, Tesfaye S. Treating Pain in Diabetic Neuropathy: Current and Developmental Drugs. Drugs. 2020;80(4):363-84.doi:10.1007/s40265-020-01259-2
33. Ardeleanu V, Toma A, Pafili K, Papanas N, Motofei I, Diaconu CC, et al. Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review. Medicina. 2020; 56(1):25.doi:10.3390/medicina56010025
34. Wiffen PJ, Derry S, Bell RF, Rice AS, Tölle TR, Phillips T, et al. Gabapentin for chronic neuropathic pain in adults. Cochrane Database Syst Rev. 2017;6(6):CD007938. doi:10.1002/14651858.CD007938.pub4
35. Raskin P, Huffman C, Toth C, Asmus MJ, Messig M, Sanchez RJ, et al. Pregabalin in Patients With Inadequately Treated Painful Diabetic Peripheral Neuropathy. Clin J Pain. 2014;30(5):379-90.doi:10.1097/AJP.0b013e31829ea1a1
36. Mu Y, Liu X, Li Q, Chen K, Liu Y, Lv X, et al. Efficacy and safety of pregabalin for painful diabetic peripheral neuropathy in a population of Chinese patients: A randomized placebo-controlled trial. J Diabetes. 2018;10(3): 256–65. doi:10.1111/1753-0407.12585
37. Derry S, Bell RF, Straube S, Wiffen PJ, Aldington D, Moore RA. Pregabalin for neuropathic pain in adults. Cochrane Database Syst Rev. 2019;1(1):CD007076. doi:10.1002/14651858.CD007076.pub3
38. Moore RA, Derry S, Aldington D, Cole P, Wiffen PJ. Amitriptyline for neuropathic pain in adults. Cochrane Database Syst Rev. 2015;(7):CD008242. doi:10.1002/14651858.CD008242.pub3
39. Brunton S, Wang F, Edwards SB, Crucitti AS, Ossanna MJ, Walker DJ, et al. Profile of adverse events with duloxetine treatment: a pooled analysis of placebo-controlled studies. Drug Saf.2010;33(5):393–407.doi:10.2165/11319200-000000000-00000
40. Lunn MP, Hughes RA, Wiffen PJ. Duloxetine for treating painful neuropathy, chronic pain or fibromyalgia. Cochrane Database Syst Rev. 2014;(1):CD007115. doi:10.1002/14651858.CD007115.pub3
41. Tesfaye S, Wilhelm S, Lledo A, Schacht A, Tölle T, Bouhassira D, et al. 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(12):2616-2625. doi:10.1016/j.pain.2013.05.043
42. Tesfaye S, Sloan G, Petrie J, White D, Bradburn M, Julious S, et al. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet. 2022;400(10353):680-90. doi:10.1016/S0140-6736(22)01472-6
43. Harati Y, Gooch C, Swenson M, Edelman S, Greene D, Raskin P, et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998;50(6):1842-46. doi:10.1212/WNL.50.6.1842
44. Vinik AI, Shapiro DY, Rauschkolb C, Lange B, Karcher K, Pennett D, et al. A randomized withdrawal, placebo-controlled study evaluating the efficacy and tolerability of tapentadol extended release in patients with chronic painful diabetic peripheral neuropathy. Diabetes Care. 2014;37(8):2302-09. doi:10.2337/dc13-2291
45. McNicol ED, Midbari A, Eisenberg E. Opioids for neuropathic pain. Cochrane Database Syst Rev. 2013;(8): CD006146. doi:10.1002/14651858.CD006146.pub2
46. 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(6):497–503.doi:10.1111/papr.12013
47. Goodwin B, Chiplunkar M, Salerno R, Coombs K, Sannoh U, Shah V, et al. Topical capsaicin for the management of painful diabetic neuropathy: a narrative systematic review. Pain Manag. 2023. doi:10.2217/pmt-2023-0006
48. Slangen R, Schaper NC, Faber CG, Joosten EA, Dirksen CD, van Dongen RT, et al. Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: a prospective two-center randomized controlled trial. Diabetes Care. 2014;37(11):3016-24. doi:10.2337/dc14-0684
49. van Beek M, Geurts JW, Slangen R, Schaper NC, Faber CG, Joosten EA, et al. Severity of Neuropathy Is Associated With Long-term Spinal Cord Stimulation Outcome in Painful Diabetic Peripheral Neuropathy: Five-Year Follow-up of a Prospective Two-Center Clinical Trial. Diabetes Care. 2018;41(1):32-38.doi:10.2337/dc17-0983
50. Petersen EA, Stauss TG, Scowcroft JA, Brooks ES, White JL, Sills SM et al. Effect of High-frequency (10-kHz) Spinal Cord Stimulation in Patients With Painful Diabetic Neuropathy: A Randomized Clinical Trial. JAMA Neurol. 2021; 78(6):687-98. doi:10.1001/jamaneurol.2021.0538
51. Petersen EA, Stauss TG, Scowcroft JA, Brooks ES, White JL, Sills SM, et al. Durability of High-Frequency 10-kHz Spinal Cord Stimulation for Patients with Painful Diabetic Neuropathy Refractory to Conventional Treatments: 12-Month Results From a Randomized Controlled Trial. Diabetes Care. 2022;45(1):3-6. doi:10.2337/dc21-1813
Published
2023-11-29
How to Cite
1.
Jiménez-Castillo GA, Martínez-Bravo LE, Anaya-Escamilla A. Diabetic Neuropathy: A narrative review of pathophysiology, diagnosis, and treatment. Acta Med Peru [Internet]. 2023Nov.29 [cited 2024May10];40(3). Available from: https://amp.cmp.org.pe/index.php/AMP/article/view/2731
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