Diabetesch Neuropathie: Nei Behandlungsrichtlinnen

The guideline is published in the December 27, 2021, online issue of Neurology®, the medical journal of the AAN, and is endorsed by the American Association of Neuromuscular & Electrodiagnostic Medicine. This guideline updates the 2011 AAN guideline on the treatment of painful diabetic neuropathy.

The guideline states that there are many oral and topical medications that are effective in reducing nerve pain. Before prescribing a treatment, it says a doctor should first determine if a person also has mood or sleep problems since treatment for these conditions is also important.

To reduce nerve pain, the guideline recommends that doctors may offer treatments from the following drug classes: tricyclic antidepressants (TCAs) such as amitriptyline, nortriptyline and imipramine; serotonin-norepinephrine reuptake inhibitors (SNRIs) such as duloxetine, venlafaxine or desvenlafaxine; gabapentinoids such as gabapentin or pregabalin; and/or sodium channel blockers such as carbamazepine, oxcarbazepine, lamotrigine, or lacosamide. Evidence shows these medications may all reduce nerve pain.

When prescribing, the guideline says doctors should consider the cost of a drug, side effects as well as other medical problems the person may have. Once taking a drug, people should be checked by their doctors to determine if there is enough pain relief or too many side effects.

If the first medication tried does not provide meaningful improvement, or if there are significant side effects, the guideline states that doctors should offer patients a trial of another medication from a different class.

The guideline states that opioids should not be considered for treatment.

The guideline states that doctors may offer topical treatments such as capsaicin, glyceryl trinitrate spray or Citrullus colocynthis to reduce pain. It also says ginkgo biloba may be helpful, as well as non-drug treatments such as exercise, mindfulness, cognitive behavioral therapy or tai chi.

To further assist neurologists and other doctors with treating painful diabetic neuropathy, the AAN has also published a new AAN Polyneuropathy Quality Measurement Set to accompany this guideline. A quality measurement set is a tool doctors can use to improve the ways care is delivered to patients.

Learn more about diabetic neuropathy at BrainandLife.org, home of the American Academy of Neurology’s free patient and caregiver magazine focused on the intersection of neurologic disease and brain health. Follow Brain & Life® on Facebook, Twitter and Instagram.

The American Academy of Neurology is the world’s largest association of neurologists and neuroscience professionals, with over 36,000 members. The AAN is dedicated to promoting the highest quality patient-centered neurologic care. A neurologist is a doctor with specialized training in diagnosing, treating and managing disorders of the brain and nervous system such as Alzheimer’s disease, stroke, migraine, multiple sclerosis, concussion, Parkinson’s disease and epilepsy.