Treatment of pain in diabetic polyneuropathy

Treatment of painful diabetic polyneuropathy involves a multimodal approach that combines drug therapy and non-drug methods. The first choice of therapy for the treatment of painful diabetic neuropathy are medications from the group of tricyclic antidepressants, anticonvulsants – pregabalin, gabapentin and antidepressants from the group of selective serotonin and norepinephrine reuptake inhibitors – duloxetine, venlafaxine.Medications of second choice are opioid analgesics, as well as capsaicin cream. In case of an unresponsive pain syndrome, it is appropriate to use a combination of medications belonging to different groups in order to potentiate their effect. The development of new therapies based on molecular and genetic research represents a promising direction for more effective control of neuropathic pain and improvement of patients’ quality of life.Attempts to phenotype pain will make it possible to search for specific individual treatment for the relevant phenotypic variant. Claims for a possible role of vitamin D deficiency in patients with painful diabetic polyneuropathy show promising data. In the future, level testing could be introduced routinely and supplement the treatment algorithm. An alternative method for influencing drug-resistant pain is repetitive transcranial magnetic stimulation (rTMS). There is a lack of standardization of the parameters and the required number of sessions to perform rTMS in patients with painful diabetic polyneuropathy.