Neuropathic Pain Management Requires Multimodal Rehabilitation, But Research Gaps Remain

diabetic peripheral neuropathy
diabatic foot skining neuropathy
Researchers did a systematic review of guidelines covering a 13-year period to evaluate recommended rehabilitative interventions for neuropathic pain.

Neuropathic pain management requires multimodal rehabilitation, but the current literature lacks clear, validated guidelines on the use of various rehabilitative practices according to research published in Diagnostics.

Although various guidelines consider rehabilitative intervention an aspect of neuropathic pain treatment, none of these guidelines include this treatment modality in an organic or detailed way. Researchers conducted a systematic review of guidelines published over a 13-year period to evaluate recommended rehabilitative interventions for people with neuropathic pain.

Six studies were selected for final inclusion in the systematic review. Current study investigators found that a variety of interventions were recommended, including neurostimulation therapy, transcutaneous electrical nerve stimulation (TENS), and multidisciplinary approaches inclusive of pharmacologic, psychological, and physical therapies. Among nonpharmacologic interventions, the studies included found that only TENS was superior to placebo therapy for painful diabetic neuropathy.

One study found that TENS, spinal cord stimulation, and cognitive behavioral therapy are all effective nonpharmacologic interventions. They specifically recommended TENS for localized peripheral neuropathic pain, spinal cord stimulation for chronic postoperative lumbar back pain, and acupuncture for postherpetic neuralgia.

In a study focused on painful diabetic neuropathy, researchers suggested that a combination of both pharmacologic and nonpharmacologic interventions would reduce pain and improve patient quality of life, while another study “stressed the crucial role of the multidisciplinary approach” in the management of neuropathic pain.

“Although some interventions like TENS therapy, physiotherapy, and psychological interventions were recommended, the [keystone] of neuropathic pain management [lies] in the implementation of multidisciplinary complex interventions focusing on all the different aspects affected by this chronic and extremely disabling pathological condition,” the researchers wrote, adding that the current literature provides a “broad agreement” that psychological issues should not be underestimated and require treatment.

Study limitations include a lack of assessment of the quality of included studies and the low to moderate quality of evidence about neuropathic pain intervention modalities. Additionally, the complexity of neuropathic pain makes diagnosis difficult.

“In this context of interdisciplinary treatment, a relevant role in nonpharmacological intervention is surely played by rehabilitation which should be implemented [in] the early phase of neuropathic pain management, acting in synergy with other interventions in order to achieve the best outcome,” the researchers concluded.


Bernetti A, Agostini F, de Sire A, et al. Neuropathic pain and rehabilitation: a systematic review of international guidelines. Diagnostics (Basel). 2021;11(1):74. doi:10.3390/diagnostics11010074