Management of painful diabetic neuropathy

Type 2 diabetes mellitus is a prevalent disease in the US which affects mor e than 15 million people. As the disease progresses over time. neuropathic pain can become a common complication; it is present in more than 50% of in dividuals with diabetes mellitus aged > 60 years. The pathogenesis of diabe tic neuropathy is theorised to be multifactorial. Numerous medications, som e with different mechanisms of action, have been examined regarding their e ffects on the symptoms associated with diabetic neuropathy such as pain, pa raesthesia and numbness. However, the majority of the studies have included small patient populations. Tricyclic antidepressants, amitriptyline and de sipramine in particular, have been relatively well studied and shown to be effective. However, anticholinergic adverse effects may limit their usefuln ess and may preclude use in the elderly. Studies have also shown gabapentin to be effective and well tolerated in the treatment of diabetic neuropathy . Capsaicin cream provides another treatment option with a favourable adver se effect profile. Many other medications have been evaluated in diabetic n europathy; however, more placebo-controlled studies with adequate patient p opulations need to be performed to solidify their role in treatment.