HealthDay News The American Academy of Neurology (AAN) has issued a practice guideline update on oral and topical treatments for painful diabetic neuropathy (PDN); a summary of the update has been published in the Jan. 4 issue of Neurology.

Raymond Price, M.D., from the University of Pennsylvania in Philadelphia, and colleagues conducted a systematic review of the medical literature from January 2008 to April 2020 to update the AAN guidelines on the treatment of PDN.

The researchers found that the effect sizes were comparable for gabapentinoids (standardized mean difference [SMD], 0.44; 95% confidence interval [CI], 0.21 to 0.67), serotonin-norepinephrine reuptake inhibitors (SNRIs; SMD, 0.47; 95% CI, 0.34 to 0.60), sodium channel blockers (SMD, 0.56; 95% CI, 0.25 to 0.87), and SNRI/opioid dual mechanism agents (SMD, 0.62; 95% CI, 0.38 to 0.86), which were all just above or below the cutoff for medium effect size (SMD, 0.5). Tricyclic antidepressants (TCAs) had a large effect size, with a wide confidence interval (SMD, 0.95; 95% CI, 0.15 to 1.8). The recommendations include assessing patients with diabetes for PDN and those with PDN for mood and sleep disorders. TCAs, SNRIs, gabapentinoids, and/or sodium blockers should be offered for pain reduction; factors other than efficacy should be considered.


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If patients do not achieve meaningful improvement or if they experience significant adverse effects with the initial therapeutic class, clinicians should offer patients a trial of medication from a different effective class. Opioids should not be used for the treatment of PDN.

“The good news is there are many treatment options for painful diabetic neuropathy, so a treatment plan can be tailored specifically to each person living with this condition,” a coauthor said in a statement.

Several authors disclosed financial ties to the pharmaceutical, medical technology, publishing, and other industries; several authors disclosed serving as expert witnesses.

Practice Guideline Update Summary

Quality Measurement Set