Treatment of Neuropathic Pain

Pathophysiology and Classification

Diabetes is the most common cause of neuropathy in developed countries, according to the American Diabetes Association 2, 1
Alcohol toxicity is a cause of neuropathy, as stated by the American Academy of Neurology 1
Chemotherapy-induced neurotoxicity is a cause of neuropathy, as reported by the European Hematology Association 3
Vitamin B12 deficiency is a cause of neuropathy, as noted by the American College of Physicians 1
Hypothyroidism is a cause of neuropathy, as stated by the American Thyroid Association 1
Renal disease is a cause of neuropathy, as reported by the National Kidney Foundation 1

Assessment of symptoms such as pain, burning, tingling, and numbness is necessary for diagnosis, as recommended by the American Academy of Neurology 1
Evaluation of small fiber involvement, including pain and dysesthesia, is necessary for diagnosis, as stated by the American Academy of Neurology 1
Testing for temperature and pinprick sensation is necessary for diagnosis, as recommended by the American Diabetes Association 2
Assessment of vibration perception and pressure sensation is necessary for diagnosis, as stated by the American Diabetes Association 2
Checking ankle reflexes is necessary for diagnosis, as recommended by the American Academy of Neurology 2
Neuroelectrophysiological examination may be necessary in unclear cases, as reported by the American Clinical Neurophysiology Society 2

Well-controlled blood glucose may delay progression of diabetic neuropathy, as stated by the American Diabetes Association 2
Near-normal glycemic control implemented early is most effective for prevention, especially in type 1 diabetes, as recommended by the American Diabetes Association 1, 4
Addressing cardiovascular risk factors, such as hypertension and hyperlipidemia, is necessary, as reported by the American Heart Association 5

Anticonvulsants, such as pregabalin and gabapentin, are effective for treating neuropathic pain, as stated by the American Academy of Neurology 5, 1
Antidepressants, such as duloxetine and tricyclic antidepressants, are effective for treating neuropathic pain, as recommended by the American Psychiatric Association 5, 1
Duloxetine is FDA-approved for diabetic peripheral neuropathy, as noted by the American Diabetes Association 5, 1

Serotonin norepinephrine reuptake inhibitors, such as venlafaxine, may be effective for treating neuropathic pain, as reported by the American Psychiatric Association 5
Opioids, such as tramadol and oxycodone, may be necessary for refractory cases, as stated by the American Pain Society 5

Screening for cardiac autonomic neuropathy using heart rate variability testing is necessary, as recommended by the American Diabetes Association 1, 4
Evaluating for gastrointestinal neuropathies is necessary if symptoms are present, as stated by the American Gastroenterological Association 1, 4
Assessing for bladder dysfunction and erectile dysfunction is necessary, as reported by the American Urological Association 2, 4
Monitoring for orthostatic hypotension and resting tachycardia is necessary, as recommended by the American Autonomic Society 4

Early detection and dose adjustment algorithms can help reduce side effects while maintaining anti-tumor efficacy, as reported by the European Hematology Association 3
Specialized neurological assessment within a multi-disciplinary approach may be necessary, as stated by the European Hematology Association 3

Regular assessment of symptom improvement is necessary, as recommended by the American Academy of Neurology 4
Annual comprehensive foot examination for diabetic patients is necessary, as stated by the American Diabetes Association 2, 1
Monitoring for treatment side effects and adjusting accordingly is necessary, as reported by the Mayo Clinic 6