DOC News June 1, 2006
Volume 3 Number 6 p. 3
© 2006 American Diabetes Association
New DPN Pain Guidelines Aim to Improve Care, Reduce Errors
Bruce Goldfarb
An expert panel of pain-management specialists has released consensus
guidelines for treating diabetic peripheral neuropathy (DPN) pain in hopes of
addressing "a desperate need for information" in primary care,
says Barry Cole, MD, executive director of the American Society of Pain
Educators (ASPE).
Jointly sponsored by ASPE and Johns Hopkins University School of Medicine
in Baltimore, and supported by an educational grant from Eli Lilly and
Company, the guidelines were published in a supplement to the April issue of
Mayo Clinic
Proceedings.1
They are intended to give health professionals a definitive, consistent
treatment strategy for managing the neuropathic pain associated with
diabetes.
In summer 2005, 11 pain management experts met for 2 days in New Orleans to
consider clinical studies and arrive at a consensus. "We brought
everybody together from academia and real-world medicine," Cole says.
"It was an elaborate process that I don't wish on anybody."
Based on the literature, the panel ranked medications into first and second
tiers. First-tier drugs include the two approved for treatment of
DPN—duloxetine (Cymbalta, Lilly) and pregabalin (Lyrica,
Pfizer)—as well as controlled-release oxycodone and tricyclic
antidepressants. Second-tier agents include carbamazepine (several brands),
gabapentin (Neurontin, Pfizer), lamotrigine (Lamictal, GlaxoSmithKline),
tramadol (Ultram, Ortho-McNeil), and venlafaxine (Effexor, Wyeth).
Several agents were designated "honorable mentions," including
topical capsaicin and lidocaine, bupropion (Wellbutrin XL, GlaxoSmithKline),
citalopram (Celexa, Parke-Davis), paroxetine (Paxil, GlaxoSmithKline),
phenytoin (Dilantin, Parke-Davis), topiramate (Topomax, Ortho-McNeil), and
opioid methadone.
About half of people with diabetes have neuropathy, such as retinopathy or
peripheral neuropathy. Common comorbidities include depression, sleep
disturbances, progressive muscle weakness, and foot ulceration. About 1
million Americans with diabetes suffer chronic and debilitating peripheral
neuropathic pain. 
Footnotes
FYI
Free copies of the treatment guidelines are available from the American
Society of Pain Educators at
www.paineducators.org/pdf/ASPE_DPNP_Consesus_Guidelines.pdf
[sic].
References
1. Consensus guidelines: Assessment, diagnosis, and treatment of
diabetic peripheral neuropathic pain. Mayo Clin Proc 81 (Suppl.): S3–S32, 2006.[Medline]
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