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Neuropathy – diabetic

from Chief complaints and diagnoses

Published online by Cambridge University Press:  18 December 2009

By
David Cline
Edited by
Stephen H. Thomas
Stephen H. Thomas
Affiliation:
Harvard Medical School
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Summary

Treatment decisions regarding diabetic neuropathy (DN) can be made based on useful evidence. Many agents have been assessed for therapy of DN pain, and many have some role in relief of symptoms. The opioid tramadol, which has additional (monoamine-related) mechanisms of analgesia, has particular utility in DN. The tricyclic antidepressants (TCAs) are among the most consistently effective therapy for neuropathic pain. Multiple RCTs have demonstrated the efficacy of the serotonin-norepinephrine reuptake inhibitor (SNRI) duloxetine in the treatment of DN. A withdrawal syndrome can occur if the SNRIs are abruptly discontinued. Anticonvulsants are a valuable therapeutic option in DN. Pregabalin is effective for DN as well. Topical application of local anesthetics may be useful in patients with focal DN pain. Patch application of lidocaine is known to be effective in DN. Intravenously injected local anesthetics have been reported potentially useful in DN.

Keywords

antacidsbismuth saltsgastritisGPUDprokinetic drugsproton pump inhibitorspeptic ulcer disease
Type
Chapter
Information
Emergency Department Analgesia
An Evidence-Based Guide
 , pp. 280 - 284
Publisher: Cambridge University Press
Print publication year: 2008

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