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The clinical landscape of painful diabetic neuropathy therapy: perspectives for clinicians from clinical practice guidelines

Vera Bril, Bruce A PerkinsJohn England

Painful diabetic neuropathy (PDN) is highly prevalent, yet there are marked limitations in the efficacy of the multiple existing symptomatic therapies. This presents a major challenge to clinicians whose aim it is to use the best evidence in treatment choice. Evidence-based guidelines provide a better understanding of the foundations for the different treatment choices and this insight may be used to improve patient care. Guidelines at this point can only speak to efficacy in the hopes that the therapies will have sufficient adherence, generalizability and affordability to treat PDN effectively in society. Different guidelines for treating PDN have recently been published, however their content and recommendations differ. An understanding of why the guidelines differ may be useful to the practitioner in choosing the best emerging evidence for the treatment of PDN patients. This review compares the different guidelines and discusses the methodologies leading to different recommendations.