Diabetic Peripheral Neuropathic Pain - An Update

Diabetic peripheral neuropathic pain (DPNP) is the clinical presentation of neuropathic pain in Painful Diabetic Peripheral Neuropathy (PDPN) and it is of two types- nerve trunk pain and hyperalgesic pain, involving both small and large nerve fiber dysfunction, secondary to insulin neuritis, glucose influx, and ectopic impulses from dorsal root ganglia, with interaction of spinal/cortical mechanisms. The paper reviews the epidemiology, mechanisms, differential diagnosis and management of DPNP and the existing evidence need to take an evidence-informed shift towards a multidisciplinary biopsychosocial perspective. The treating clinician needs to be aware of the clinical findings, neurodynamic findings, its inter-relationship with other factors such as quality of life, and scores obtained on clinical assessment scales for staging the condition so that an integrated approach involving judicious use of medical, surgical, physiotherapeutic and complementary/alternative medicine methods can be employed for comprehensive management of the condition.