Emerging drugs for diabetic peripheral neuropathy and neuropathic pain

Abstract Background Acupuncture is used to treat patients with diabetic peripheral neuropathy; however, the evidence is unclear. We present the design and methodology of the ACUDPN (ACUpuncture in Diabetic Peripheral Neuropathy) trial, which investigates the effectiveness of acupuncture for the treatment of diabetic peripheral neuropathy (DPN) symptoms. The aim of this study is to investigate whether acupuncture is effective for the treatment of DPN symptoms. Methods This study is a two-armed, randomized, controlled, parallel group, open-label, confirmatory, multicenter trial (8-week intervention period plus 16 weeks of follow-up). Physicians in outpatient units in Germany who specialize in acupuncture treatment will treat 110 diabetes type II patients with clinical symptoms of peripheral neuropathy in the feet and legs with signs of neuropathy according to nerve conduction testing. The patients will be randomized in a 1:1 ratio to one of the following two groups: (a) semi-standardized acupuncture plus routine care or (b) routine care alone. Acupuncture will consist of 12 treatments per patient over 8 weeks. The primary outcome will be the overall DPN-related complaints in the extremities after 8 weeks as measured by the Visual Analog Scale (VAS). Further outcome measures will include DPN-related pain, the Neuropathic Pain Symptom Inventory (NPSI), Diabetic Peripheral Neuropathic Pain Impact (DPNPI) scores, and nerve conduction parameters of the sural nerve at weeks 8, 16, and 24. Discussion The results of this trial will be available in 2021 and will help clarify whether acupuncture can be considered effective for the treatment of DPN with regard to the subdimensions of the neuropathic clinical picture. Trial registration ClinicalTrials.gov NCT03755960. Registered on 11 August 2018.

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A critical review of the capsaicin 8% patch for the treatment of neuropathic pain associated with diabetic peripheral neuropathy of the feet in adults

Expert Review of Neurotherapeutics ◽

10.1080/14737175.2021.1874920 ◽

2021 ◽

pp. 1-8

Author(s):

Rory M. C. Abrams ◽

Elizabeth J. Pedowitz ◽

David M. Simpson

Keyword(s):

Neuropathic Pain ◽

Peripheral Neuropathy ◽

Critical Review ◽

Diabetic Peripheral Neuropathy

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1580 The efficacy, safety, and tolerability of pregabalin treatment for neuropathic pain associated with diabetic peripheral neuropathy or postherpetic neuralgia: findings from the analysis of 10 randomized clinical trials

Journal of the Neurological Sciences ◽

10.1016/s0022-510x(05)81937-9 ◽

2005 ◽

Vol 238 ◽

pp. S501-S502

Keyword(s):

Clinical Trials ◽

Neuropathic Pain ◽

Peripheral Neuropathy ◽

Postherpetic Neuralgia ◽

Diabetic Peripheral Neuropathy ◽

Randomized Clinical Trials

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Diabetic Peripheral Neuropathy: Epidemiology, Physiopathology, Diagnosis and Treatment

Delta Medical College Journal ◽

10.3329/dmcj.v7i1.40619 ◽

2019 ◽

Vol 7 (1) ◽

pp. 35-48

Author(s):

Nazma Akter

Keyword(s):

Neuropathic Pain ◽

Peripheral Neuropathy ◽

Diabetic Peripheral Neuropathy ◽

Clinical Evidence ◽

Current Treatment ◽

Diabetic Patients ◽

First Line ◽

Diabetic Neuropathic Pain ◽

Current Treatment Regimen ◽

Limb Proprioception

Diabetic peripheral neuropathy (DPN) is a common complication of both type 1 and type 2 diabetes. It affects over 90% of the diabetic patients. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. It is typically characterized by significant deficits in tactile sensitivity, vibration sense, lower-limb proprioception, and kinesthesia. Painful DPN has been shown to be associated with significant reductions in overall quality of life, increased levels of anxiety and depression, sleep impairment, and greater gait variability. DPN is often misdiagnosed and inadequately treated. Clinical recognition of DPN is imperative for allowing timely symptom management to reduce the morbidity associated with this condition. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvant in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. The purpose of this review is to examine proposed mechanisms of DPN, summarize current treatment regimen. A better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies. Delta Med Col J. Jan 2019 7(1): 35-48

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Efficacy of Chinese Herbal Medicine in the Treatment of Moderate-Severe Painful Diabetic Peripheral Neuropathy: A Retrospective Study

Journal of Diabetes Research ◽

10.1155/2019/4035861 ◽

2019 ◽

Vol 2019 ◽

pp. 1-10

Author(s):

Yujiao Zheng ◽

Fan Yang ◽

Lin Han ◽

Xiaowen Gou ◽

Fengmei Lian ◽

...

Keyword(s):

Neuropathic Pain ◽

Retrospective Study ◽

Blood Glucose ◽

Peripheral Neuropathy ◽

Herbal Medicine ◽

Chinese Herbal Medicine ◽

Diabetic Peripheral Neuropathy ◽

Limb Pain ◽

Chinese Herbal ◽

Painful Diabetic Peripheral Neuropathy

Painful diabetic peripheral neuropathy (pDPN) is a debilitating complication of diabetes. The aim of this retrospective study was to investigate the effectiveness of a Chinese herbal medicine regimen—the modified Huangqi Guizhi Wuwu Decoction (HGWD)—in the treatment of moderate-severe pDPN. The primary objective was to estimate the improvement in neuropathic pain severity. The secondary objective was to assess the response of common symptoms to the treatment. The change in patients’ blood glucose level during the whole treatment was also evaluated. By searching through our medical records of all the diabetic patients from January 2006 to January 2012, we identified and enrolled 30 moderate and severe pDPN patients in the study, for whom the treatment of neuropathic pain by regular pharmacotherapies had failed. The modified HGWD treatment was administered orally twice a day for 6 months. The numerical rating scale (NRS) level at month 6 was 2.57±2.30, significantly improved compared with the baseline level of 6.03±1.83 (P<0.05). The amelioration of 3 common symptoms, namely, limb pain, limb numbness, and insomnia, was evident, and the major response of common symptoms at month 6 including limb pain, insomnia, and limb coldness was significantly increased compared with the results at month 3 (P<0.05). Moreover, 2-hour postprandial blood glucose (2hPG) level decreased from 10.77±1.29 mmol/L at baseline to 9.66±0.60 mmol/L at month 6 (P<0.05). No serious adverse events occurred throughout the treatment period. The modified HGWD was effective in the treatment of moderate and severe pDPN and can thus be offered as a new alternative treatment option for pDPN patients who failed to respond to regular pharmaceutical therapies.

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