Diabetic neuropathy is the most common chronic complication of diabetes, affecting around half of all people living with diabetes during their lifetime. Peripheral neuropathy is a subset of nerve damage that causes pain, numbness, or weakness in the extremities, such as hands, feet, and arms. Pain associated with diabetic peripheral neuropathy is estimated to affect around a quarter of people living with diabetes throughout their lifetime, is often debilitating and is associated with increased risk for sleep and mood disorders. Managing neuropathy-associated pain should, therefore, be considered a priority in order to improve quality of life for people living with diabetes.
Diabetic peripheral neuropathy is challenging to treat. Current standard of care includes pharmacological treatment with amitriptyline, duloxetine, gabapentin or pregabalin. Capsaicin cream is an option for individuals who cannot tolerate, or choose to avoid, oral treatments. In specific circumstances, tramadol can be used as acute rescue therapy for a limited period but is not an option for long-term treatment. While these recommendations are widely accepted, they are not based upon robust evidence and, despite the availability of such treatments, persistent pain is reported by many individuals receiving treatment for diabetic peripheral neuropathy. Combination therapy is not widely recommended due to a lack of available evidence.
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