{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,3]],"date-time":"2026-11-03T13:08:24Z","timestamp":1793711304279,"version":"4.6.1"},"reference-count":84,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2020,1,9]],"date-time":"2020-01-09T00:00:00Z","timestamp":1578528000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Distal symmetrical polyneuropathy (DSPN) is one of the most common chronic complications of diabetes mellitus. Although it is usually characterized by progressive sensory loss, some patients may develop chronic pain. Assessment of DSPN is not difficult, but the biggest challenge is making the correct diagnosis and choosing the right treatment. The treatment of DSPN has three primary objectives: glycemic control, pathogenic mechanisms, and pain management. The aim of this brief narrative review is to summarize the current pharmacological treatment of painful DSPN. It also summarizes knowledge on pathogenesis-oriented therapy, which is generally overlooked in many publications and guidelines. Materials and Methods: The present review reports the relevant information available on DSPN treatment. The search was performed on PubMed, Cochrane, Semantic Scholar, Medline, Scopus, and Cochrane Library databases, including among others the terms \u201cdistal symmetrical polyneuropathy\u201d, \u201cneuropathic pain treatment\u201d, \u201cdiabetic neuropathy\u201d, \u201cdiabetes complications\u201d, \u201dglycaemic control\u201d, \u201cantidepressants\u201d, \u201copioids\u201d, and \u201canticonvulsants\u201d. Results: First-line drugs include antidepressants (selective serotonin reuptake inhibitors and tricyclic antidepressants) and pregabalin. Second- and third-line drugs include opioids and topical analgesics. While potentially effective in the treatment of neuropathic pain, opioids are not considered to be the first choice because of adverse reactions and addiction concerns. Conclusions: DSPN is a common complication in patients with diabetes, and severely affects the quality of life of these patients. Although multiple therapies are available, the guidelines and recommendations regarding the treatment of diabetic neuropathy have failed to offer a unitary consensus, which often hinders the therapeutic options in clinical practice.<\/jats:p>","DOI":"10.3390\/medicina56010025","type":"journal-article","created":{"date-parts":[[2020,1,10]],"date-time":"2020-01-10T04:06:51Z","timestamp":1578629211000},"page":"25","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":49,"title":["Current Pharmacological Treatment of Painful Diabetic Neuropathy: A Narrative Review"],"prefix":"10.3390","volume":"56","author":[{"given":"Valeriu","family":"Ardeleanu","sequence":"first","affiliation":[{"name":"Department of Surgery, University \u201cDunarea de Jos\u201d, 800008 Galati, Romania"},{"name":"Department of Surgery, University \u201cOvidius\u2019\u2019, 900470 Constanta, Romania"},{"name":"Arestetic Clinic, 800098 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexandra","family":"Toma","sequence":"additional","affiliation":[{"name":"Department of Surgery, University \u201cDunarea de Jos\u201d, 800008 Galati, Romania"},{"name":"Department of Surgery, Emergency County Clinical Hospital \u201cSf. Apostol Andrei\u201d, 800578 Galati, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kalliopi","family":"Pafili","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nikolaos","family":"Papanas","sequence":"additional","affiliation":[{"name":"Second Department of Internal Medicine, Diabetes Centre-Diabetic Foot Clinic, Democritus University of Thrace, University Hospital of Alexandroupolis, 681 00 Alexandroupolis, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ion","family":"Motofei","sequence":"additional","affiliation":[{"name":"Department of Surgery, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6837-260X","authenticated-orcid":false,"given":"Camelia Cristina","family":"Diaconu","sequence":"additional","affiliation":[{"name":"Internal Medicine Department, Clinical Emergency Hospital of Bucharest, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manfredi","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Biomedical Department of Internal Medicine and Medical Specialties School of Medicine, University of Palermo, 90133 Palermo, Italy"},{"name":"Division of Endocrinology, Diabetes and Metabolism, University of South Carolina School of Medicine Columbia, Columbia, SC 29209, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0555-526X","authenticated-orcid":false,"given":"Anca","family":"Pantea Stoian","sequence":"additional","affiliation":[{"name":"Diabetes, Nutrition and Metabolic Diseases Department, \u201cCarol Davila\u201d University of Medicine and Pharmacy, 050474 Bucharest, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,1,9]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"136","DOI":"10.2337\/dc16-2042","article-title":"Diabetic neuropathy: A position statement by the American Diabetes Association","volume":"40","author":"Boulton","year":"2017","journal-title":"Diabetes Care"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1016\/B978-0-444-53480-4.00001-1","article-title":"Epidemiology of polyneuropathy in diabetes and prediabetes","volume":"Volume 126","author":"Ziegler","year":"2014","journal-title":"Handbook of Clinical Neurology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1900\/RDS.2015.12.48","article-title":"Risk factors and comorbidities in diabetic neuropathy: An update 2015","volume":"12","author":"Papanas","year":"2015","journal-title":"Rev. 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