When patients do not experience meaningful improvement with initial therapeutic class, medication from different class should be offered<\/p>\n<\/h3>\n
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THURSDAY, Dec. 30, 2021 (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<\/em>.<\/p>\n 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.<\/p>\n The researchers found that the effect sizes were comparable for gabapentinoids (standardized mean difference [SMD], 0.44; 95 percent confidence interval [CI], 0.21 to 0.67), serotonin-norepinephrine reuptake inhibitors (SNRIs; SMD, 0.47; 95 percent CI, 0.34 to 0.60), sodium channel blockers (SMD, 0.56; 95 percent CI, 0.25 to 0.87), and SNRI\/opioid dual mechanism agents (SMD, 0.62; 95 percent 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 percent 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. 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.<\/p>\n “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.<\/p>\n Several authors disclosed financial ties to the pharmaceutical, medical technology, publishing, and other industries; several authors disclosed serving as expert witnesses.<\/p>\n Practice Guideline Update Summary<\/a><\/p>\n