December CPE Article Management of Diabetes-Related Neuropathic Pain Author: Lourdes Cross, PharmD, BCACP, CDCES and Long Phan, PharmD; Sullivan University College of Pharmacy and Health Sciences The author declare that there are no financial relationships that could be perceived as real or apparent conflicts of interest. Universal Activity #0143-0000-20-012-H01-P&T 2.5 Contact Hours Expires 12/14/23 Goal: To aid pharmacists and pharmacy technicians in understanding of current recommendations for treatment of pain associated with diabetic peripheral neuropathy and to assist with appropriate use of medications. Learning Objectives: At the conclusion of this Knowledge-based article, the reader should be able to: 1.
Describe the epidemiology of diabetic peripheral neuropathy (DPN)
2.
Discuss pharmacologic recommendations for the management of DPN
3.
Compare and contrast pharmacologic options for the management of DPN
Introduction
and gabapentinoid antiepileptic agents. Capsaicin is also an option, but it is generally poorly tolerated. Diabetic peripheral neuropathy (DPN) is a major In the United States, the three medications that complication of diabetes, with a reported prevaare FDA-approved are duloxetine, pregabalin, and lence of 30% in hospitalized patients and 20% in the capsaicin patch (8%). Comparative efficacy is ambulatory patients.1 As the duration of diabetes similar among the first-line medication options. A increases, so does the risk of developing neuropatwo- to three-month trial is usually required to asthy. An estimated 7% to 10% of patients newly diagsess response to initial therapy. nosed with diabetes have neuropathy, and this number increases to 50% in patients with longterm diabetes (>25 years duration).2 Patients may First-line Pharmacotherapy describe symptoms as numbness (similar to wearing gloves or socks), tingling, burning, aching, or sensitivity to touch. Peripheral neuropathy is one of Serotonin-Norepinephrine Reuptake Inhibitors the most important risk factors for amputations Duloxetine, a serotonin-norepinephrine reuptake and ulcers in people with diabetes, and it also ininhibitor (SNRI), is a first-line treatment option for creases risk for gait instability and falls. Furthermore, it may lead to insomnia, depression, anxiety, painful DPN given its efficacy, safety, and tolerabillimited mobility, and overall reduced quality of life. ity. It is also FDA-approved for use in patients with Established neuropathy is generally not reversible, major depressive disorder, generalized anxiety disso the primary goal of management is to slow pro- order, fibromyalgia, or chronic musculoskeletal gression, prevent complications, and alleviate pain. pain. The recommended initial dose of duloxetine for DPN is 60 mg daily. Lower doses may be considered when tolerability is a concern. In one systemic review which included 2,728 participants, Treatment for Neuropathic Pain duloxetine 60 mg daily compared to placebo was Management of neuropathic pain is an important effective in reducing pain by ≼50% at 12 weeks (risk component of care in patients with DPN. First-line ratio [RR] 1.73, 95% confidence interval [CI] 1.44pharmacotherapy options include antidepressants |25| www.KPHANET.org
