Diabetic neuropathic pain： Physiopathology and treatment
摘要
Diabetic neuropathy is a common complication of bothtype 1 and type 2 diabetes, which affects over 90% ofthe diabetic patients. Although pain is one of the mainsymptoms of diabetic neuropathy, its pathophysiologicalmechanisms are not yet fully known. It is widelyaccepted that the toxic effects of hyperglycemia play animportant role in the development of this complication,but several other hypotheses have been postulated.The management of diabetic neuropathic pain consistsbasically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvants in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. In conclusion, a better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies, but also to the improvement of the guidelines to optimize pain control with the drugs currently available.