An Insight into Potential Pharmacotherapeutic Agents for Painful Diabetic Neuropathy

Abstract

Diabetes is the 4th most common disease affecting the world’s population. It is accompanied by many complications that deteriorate the quality of life. Painful diabetic neuropathy (PDN) is one of the debilitating consequences of diabetes that effects one-third of diabetic patients. Unfortunately, there is no internationally recommended drug that directly hinders the pathological mechanisms that result in painful diabetic neuropathy. Clinical studies have shown that anticonvulsant and antidepressant therapies have proven fruitful in management of pain associated with PDN. Currently, the FDA approved medications for painful diabetic neuropathies include duloxetine, pregabalin, tapentadol extended release, and capsaicin (for foot PDN only). The FDA has also approved the use of spinal cord stimulation system for the treatment of diabetic neuropathy pain. The drugs recommended by other regulatory bodies include gabapentin, amitriptyline, dextromethorphan, tramadol, venlafaxine, sodium valproate, and 5 % lidocaine patch. These drugs are only partially effective and have adverse effects associated with their use. Treating painful symptoms in diabetic patient can be frustrating not only for the patients but also for health care workers, so additional clinical trials for novel and conventional treatments are required to devise more effective treatment for PDN with minimal side effects. This review gives an insight on the pathways involved in the pathogenesis of PDN and the potential pharmacotherapeutic agents. This will be followed by an overview on the FDA-approved drugs for PDN and commercially available topical analgesic and their effects on painful diabetic neuropathies.

Cortexin® Ameliorates High Glucose-Induced Neuropathy in Cultured Rat Sensory Neurons

“…The increase in AUC of Cell Index values might be resulting from neurotrophic actions of Cortexin ® . Experimental and clinical studies indicate that neurotrophic factors appear to be a strong candidate for complications in diabetes including painful diabetic neuropathy [17][18][19]. Indeed, there is evidence that Cortexin ® has direct and indirect neurotrophic effects which is implicated to mediate its protective and restorative actions in central nervous system neurons [10,16].…”

Diagnosis and Management of Neuropathic Pain in Spine Diseases

“…Duloxetine and venlafaxine are the most studied serotonin and norepinephrine reuptake inhibitors (SNRIs) for neuropathic pain treatment. These agents have been approved by the FDA for the treatment of fibromyalgia, diabetic neuropathy and back pain [ 114 , 115 , 116 ]. Due to the similarity of effects exerted by SNRIs to TCAs ones, their analgesic properties possibly result from increasing the level of noradrenaline in the dorsal horn of the spinal cord and locus coeruleus [ 111 ].…”

Особливості Фармакологічної Корекції Соматичних Проявів Депресії Та Когнітивного Зниження У Хворих Із Тривожно-Депресивними Розладами У Воєнний Час

“…Нині існує тільки 4 фармакологічні засоби для лікування ДПНБ, які схвалені FDA, і на 1-му місці серед них -дулоксетин. Саме дулоксетин рекомендований FDA в якості препарату 1-ї лінії для лікування ДПНБ [34], а Американська діабетична асоціація (American Diabetes Association) рекомендує застосовувати його в якості ініціальної терапії нейропатичного болю у хворих на цукровий діабет (сильна рекомендація, А) [35]. Дані нещодавно опублікованого систематичного огляду також підтверджують доцільність застосування дулоксетину у хворих на ДПНБ [36].…”