- Special Article
Evidence-based guideline: Treatment of painful diabetic neuropathy
Report of the American Academy of Neurology,
the American Association of Neuromuscular and Electrodiagnostic
Medicine, and the American Academy of Physical Medicine and
Rehabilitation 
- V. Bril, MD, FRCP(C),
- J. England, MD, FAAN,
- G.M. Franklin, MD, MPH, FAAN,
- M. Backonja, MD,
- J. Cohen, MD, FAAN,
- D. Del Toro, MD,
- E. Feldman, MD, PhD, FAAN,
- D.J. Iverson, MD, FAAN,
- B. Perkins, MD, FRCP(C), MPH,
- J.W. Russell, MD, MS, FRPC and
- D. Zochodne, MD
- From the University Health Network (V.B., B.P.), University of Toronto, Toronto, Canada; Department of Neurology (J.E.), LSU School of Medicine, New Orleans, LA; University of Washington (G.M.F.), Seattle; University of Wisconsin (M.B.), Madison; Dartmouth Hitchcock Medical Center (J.C.), Lebanon, NH; Department of PM&R (D.D.), Medical College of Wisconsin, Milwaukee; University of Michigan (E.F.), Ann Arbor; Humboldt Neurological Medical Group, Inc. (D.J.I.), Eureka, CA; Department of Neurology (J.W.R.), University of Maryland School of Medicine, Baltimore; and University of Calgary (D.Z.), Calgary, Canada.
- Address correspondence and reprint requests to American Academy of Neurology, 1080 Montreal Avenue, St. Paul, MN 55116 guidelines{at}aan.com
Abstract
Objective:To develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN).
Methods:We performed a systematic review of the literature from 1960 to August 2008 and classified the studies according to the American Academy of Neurology classification of evidence scheme for a therapeutic article, and recommendations were linked to the strength of the evidence. The basic question asked was: “What is the efficacy of a given treatment (pharmacologic: anticonvulsants, antidepressants, opioids, others; and nonpharmacologic: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?”
Results and Recommendations:Pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness, and few studies have sufficient information on treatment effects on function and QOL.
Footnotes
-
- AAN
- American Academy of Neurology
- NNT
- number needed to treat
- PDN
- painful diabetic neuropathy
- QOL
- quality of life
- RCT
- randomized controlled trial
- SF-MPQ
- Short Form–McGill Pain Questionnaire
- SF-QOL
- Short Form–Quality of Life
- VAS
- visual analog pain scale
-
Supplemental data at www.neurology.org
-
Appendices e-1–e-5 and References e-1–e46 are available on the Neurology® Web site at www.neurology.org.
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Approved by the AAN Quality Standards Subcommittee on November 13, 2010; by the AAN Practice Committee on December 15, 2010; by the AAN Board of Directors on February 10, 2011; by the Neuromuscular Guidelines Steering Committee on October 8, 2010; by the AANEM Practice Issues Review Panel on January 15, 2011; by the AANEM Board of Directors on February 15, 2011; by the AAPM&R Quality Practice & Policy Committee on February 6, 2011; and by the AAPM&R Board of Governors on March 11, 2011.
- Received December 15, 2010.
- Accepted February 15, 2011.
- Copyright © 2011 by AAN Enterprises, Inc.
-
Published online before print April 11, 2011, doi: 10.1212/WNL.0b013e3182166ebe Neurology May 17, 2011 vol. 76 no. 20 1758-1765
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- Clinical/Scientific Notes
Fractal dimension of the retinal vasculature and risk of stroke: A nested case-control study
- From the Centre for Eye Research Australia (R.K., T.Y.W., J.J.W.), University of Melbourne, Victoria; Royal Victorian Eye and Ear Hospital (R.K.), Victoria; School of Electrical and Computer Engineering (M.Z.C.A., D.K.K.), RMIT University, Victoria; Centre for Vision Research (A.G.T., G.L., P.M., J.J.W.), University of Sydney, NSW, Australia; and Singapore Eye Research Institute (T.Y.W.), Singapore National Eye Centre, Singapore.
- Address correspondence and reprint requests to Dr. Jie Jin Wang, Centre for Eye Research Australia, University of Melbourne, 32 Gisborne Street, Victoria 3002 Australia; jiejw{at}unimelb.edu.au
Recent studies show associations between retinal vascular changes and small infarcts detected on brain imaging, or clinical stroke.1 Fractal dimension has been used as a global measure of the geometric pattern of the retinal vasculature2,3 potentially representing the complex branching pattern of the microvasculature, including the cerebral microvasculature. We have developed an automatic method to assess spectrum fractal dimension (SFD) of the retinal microvasculature using Fourier-transformed images.4,5
Two previous studies have reported cross-sectional associations between retinal fractal dimension and lacunar stroke.6,7 In this study, we aimed to examine the association between baseline SFD and stroke incidence using a case-control sample nested in the Blue Mountains Eye Study (BMES).
Methods.
The BMES is a population-based cohort study of an urban population aged 49 years or older (n = 3,654), representing 82.4% of eligible population in a defined area of the Blue Mountains region, Australia.1 Stroke cases were defined among participants with no past history of stroke at baseline (1992–1994) but who developed stroke during the subsequent 5 years (1997–1999), or who died from stroke or stroke-related causes by late 2005. Detailed definitions of stroke events and mortality are shown in …


- R. Kawasaki,
- M.Z. Che Azemin,
- D.K. Kumar,
- A.G. Tan,
- G. Liew,
- T.Y. Wong,
- P. Mitchell,
- and J.J. Wang
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- R. Kawasaki,
- M.Z. Che Azemin,
- D.K. Kumar,
- A.G. Tan,
- G. Liew,
- T.Y. Wong,
- P. Mitchell,
- and J.J. Wang
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