Reduction of Diabetic Neuropathy Associated Pain
Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can anytime develop nerve damage throughout the body. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose as well as those with high levels of blood fat, blood pressure and those who are overweight.
Painful diabetic neuropathy (PDN) is a disabling pain condition. Its pathophysiology remains unknown, but sensitization and neuronal hyper excitability have been suggested.
The origin of painful diabetic neuropathy and the evidence-based therapeutic guidelines therefore consist only of antidepressants and anti-epileptics as first line recommended drugs. The results of the meta-analysis from the aspect of the efficacy of amitriptyline, duloxetine, venlafaxine, gabapentin and pregabalin are favorable, but the placebo response rate is relatively high in patients with neuropathic pain.
For personalization of medication of PDN patients, the optimum dosing, genotyping of the metabolizing enzymes and optimum biomarkers are needed. As concerns the future perspectives, specific sodium channel subtype inhibitors acting on peripheral nociceptive neurons or modified T-type voltage-gated calcium channel blockers might be promising targets for pharmaceutical innovations. Another attractive strategy for the treatment was based on the effects of monoclonal antibodies against nerve growth factor, sodium channels, specific receptor and cytokines. Botulinum toxin A, capsaicin patch and spinal cord stimulation therapies were the nearest future therapeutic options for the treatment of PDN patients.