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The number of people suffering from painful diabetic polyneuropathy (PDPN) has increased significantly over the past decades.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>The literature on the diagnosis and treatment of diabetic polyneuropathy was retrieved and summarized.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The etiology of PDPN is complex, with primary damage to peripheral nociceptors and altered spinal and supra\u2010spinal modulation. To achieve better patient outcomes, the mode of diagnosis and treatment of PDPN evolves toward more precise pain\u2010phenotyping and genotyping based on patient\u2010specific characteristics, new diagnostic tools, and prior response to pharmacological treatments. According to the Toronto Diabetic Neuropathy Expert Group, a presumptive diagnosis of \u201cprobable PDPN\u201d is sufficient to initiate treatment. Proper control of plasma glucose levels, and prevention of risk factors are essential in the treatment of PDPN. Mechanism\u2010based pharmacological treatment should be initiated as early as possible. If symptomatic pharmacologic treatment fails, spinal cord stimulation (SCS) should be considered. In isolated cases, where symptomatic pharmacologic treatment and SCS are unsuccessful or cannot be used, sympathetic lumbar chain neurolysis and\/or radiofrequency ablation (SLCN\/SLCRF), dorsal root ganglion stimulation (DRGs) or posterior tibial nerve stimulation (PTNS) may be considered. However, it is recommended that these treatments be applied only in a study setting in a center of expertise.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The diagnosis of PDPN evolves toward pheno\u2010and genotyping and treatment should be mechanism\u2010based.<\/jats:p><\/jats:sec>","DOI":"10.1111\/papr.13308","type":"journal-article","created":{"date-parts":[[2023,10,20]],"date-time":"2023-10-20T07:00:18Z","timestamp":1697785218000},"page":"308-320","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["4. Painful diabetic polyneuropathy"],"prefix":"10.1111","volume":"24","author":[{"given":"Xander","family":"Zuidema","sequence":"first","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Maastricht University Medical Centre  Maastricht The Netherlands"},{"name":"Department of Anesthesiology and Pain Management Diakonessenhuis Utrecht\/Zeist  Utrecht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bastiaan","family":"de Galan","sequence":"additional","affiliation":[{"name":"Division of Endocrinology, Department of Internal Medicine Maastricht University Medical Centre  Maastricht The Netherlands"},{"name":"CARIM School for Cardiovascular Diseases Maastricht University  Maastricht The Netherlands"},{"name":"Department of Internal Medicine Radboud University Medical Centre  Nijmegen The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brigitte","family":"Brouwer","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology and Pain Medicine Maastricht University Medical Centre  Maastricht The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Steven P.","family":"Cohen","sequence":"additional","affiliation":[{"name":"Department of Anesthesiology, Pain Medicine Division Johns Hopkins School of Medicine  Baltimore Maryland USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9250-1886","authenticated-orcid":false,"given":"Sam","family":"Eldabe","sequence":"additional","affiliation":[{"name":"Department of Pain Medicine and Anesthesiology Durham University  Durham UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charles E.","family":"Argoff","sequence":"additional","affiliation":[{"name":"Department of Neurology, New York University 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