AAN Guidelines for Diabetic Neuropathy Updated

The American Academy of Neurology (AAN) has updated the 2011 AAN guideline on the treatment of painful diabetic neuropathy. There are many oral and topical medications that are effective in reducing nerve pain listed in the guideline. 
 
The guideline recommends treatments from the following drug classes for nerve pain: 
•    tricyclic antidepressants (TCAs)
o    amitriptyline
o    nortriptyline
o    imipramine
•    serotonin-norepinephrine reuptake inhibitors (SNRIs) 
o    duloxetine
o    venlafaxine
o    desvenlafaxine
•    gabapentinoids 
o    gabapentin
o    pregabalin
•    sodium channel blockers 
o    carbamazepine
o    oxcarbazepine
o    lamotrigine
o    lacosamide

Topical treatments are also recommended by the guidelines such as capsaicin, glyceryl trinitrate spray or Citrullus colocynthis to reduce pain. Ginkgo biloba may be helpful, as well as nondrug treatments such as exercise, mindfulness, cognitive behavioral therapy or tai chi.

“It is important to note that the recommended drugs and topical treatments in this guideline may not eliminate pain, but they have been shown to reduce pain,” said guideline author Brian C. Callaghan, MD, MS, of the University of Michigan in Ann Arbor and a Fellow of the American Academy of Neurology. “The good news is there are many treatment options for painful diabetic neuropathy, so a treatment plan can be tailored specifically to each person living with this condition.”
 
When prescribing, doctors should consider the cost of a drug, side effects as well as other medical problems the person may have and have a follow up visits with patients. The guidelines state if one treatment class doesn’t work try a different one, but not to use opioids. The guidelines does not address neuromodulation for diabetic neuropathy.

The AAN also published a new AAN Polyneuropathy Quality Measurement Set to accompany this guideline. A quality measurement set is a tool that can be use to improve the ways care is delivered.