Treatment Options for Painful Diabetic Neuropathy

Continuing the discussion on painful diabetic neuropathy, Charles E. Argoff, MD, describes several agents that have received the green light from the US Food and Drug Administration (FDA) for the treatment of the neuropathic pain condition, as well as new medications that are seeking FDA approval and old options that aren’t likely to ever obtain it.

Though Argoff explains that “there’s no shortage of options for a person who has painful diabetic neuropathy,” he notes that there are a wide range of guidelines to consider before initiating any treatment.

For example, duloxetine, pregabalin, and tapentadol are all FDA approved for the treatment of painful diabetic neuropathy, but Argoff cautions that “two out of those three are considered controlled substances, so that’s of interest when thinking about how you’re going to prescribe.”

Additionally, Argoff says the tricyclic antidepressants — which include amitriptyline, nortriptyline, desipramine, and imipramine — are “most likely to reduce pain” in diabetes patients with the condition, though he warns that those medications have been off-patent and generic for a long period of time, and “they’re also dirty when it comes to side effects.”

To avoid potentially fatal complications, Argoff recommends applying lidocaine or capsaicin patches, as those topical treatments “can be very, very effective because they don’t have any systemic consequences.”

In case those existing options and long-acting opioid analgesics fail in a diabetic neuropathy patient, Argoff notes that experimental studies are being done with Botox for the management of the condition.