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SUPPLEMENT ARTICLE| Volume 81, ISSUE 4, SUPPLEMENT , S12-S25, April 2006

Consensus Guidelines: Treatment Planning and Options

      Despite the number of patients affected by diabetic peripheral neuropathic pain (DPNP), little consensus exists about the pathophysiology, best diagnostic tools, and primary treatment choices. Theories about the causes of DPNP are inextricably linked with the causes of diabetic neuropathies, yet most patients with such neuropathies do not experience pain. The factors that differentiate patients with pain from those without remain unknown and are the subject of much research. When choosing treatment for patients with DPNP, physicians are confronted with a myriad of choices, none of which has been shown to be effective for all patients. This article reviews the evidence for these treatments and attempts to guide physicians in choosing those treatments based on evidence from well-designed clinical trials to support their use. Two agents, duloxetine and pregabalin, are formally approved by the Food and Drug Administration for the treatment of DPNP. In addition, several other agents, including the tricyclic class of antidepressants, have been effective in clinical trials. Ultimately, treatment choice must also include consideration of adverse effects, individual patient factors such as comorbidities, and often cost.
      APS (average pain score), CI (confidence interval), CR (controlled release), DPN (diabetic peripheral neuropathy), DPNP (diabetic peripheral neuropathic pain), ER (extended release), FDA (Food and Drug Administration), NNT (number needed to treat), PHN (postherpetic neuralgia), SF-36 (Medical Outcomes Study 36-Item Short-Form Health Survey), SNRI (serotonin-norepinephrine reuptake inhibitor), SSRI (selective serotonin reuptake inhibitor), TCA (tricyclic antidepressant), VAS (visual analog scale)
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        Mayo Clinic ProceedingsVol. 81Issue 6
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          Incorrect word: In the Supplement article by Argoff et al entitled “Consensus Guidelines: Treatment Planning and Options,” published with the April 2006 issue of Mayo Clinic Proceedings (Mayo Clin Proc. 2006;81[4, suppl]:S12-S25), an incorrect word appeared in Table 2 under the heading “Class” and the entry “Opioids.” The word “block” should be replaced by the words “bind to.” Thus, the entry should read as follows: “Opioids (bind to opioid receptors).”
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