“…Evidence suggests that up-regulation of cyclooxygenase-2 (COX-2) in the peripheral nerves and dorsal root ganglia neurons, as well as, raised serum tumor necrosis factor alpha (TNF ␣ ) play an important role in the pathogenesis of painful diabetic neuropathy [18,[42][43][44]. Therefore, the antinociceptive effects of ibuprofen [18,45], aspirin [40,46], and paracetamol [21,47,48] in this type of pain could be explained by their inhibition of COX-2 and ability to decrease TNF ␣ levels. It has been recently shown that ibuprofen [49], and aspirin [50] inhibit microglial activity, which could also explain their effectiveness in diabetic neuropathy, as activated microglia may be involved in the development of diabetic neuropathy [51,52].…”