Оптимізація терапії болю у пацієнтів з діабетичною поліневропатією: нові підходи та перспективи (огляд літератури)

Diabetic sensorimotor polyneuropathy is one of the most common complications of diabetes mellitus, which increaDiabetic sensorimotor polyneuropathy is one of the most common complications of diabetes mellitus, which increases the risk of mortality, worsens the quality of life, and increases the economic costs of treating pain or managing diabetic foot. Diabetic polyneuropathy remains a challenge for physicians due to the wide range of medications and alternative treatments, most of which are not effective in clinical trials and do not adhere to the principles of evidence-based medicine. The purpose of the study was to analyze and systematize current literature data within the framework of evidence-based medicine for the treatment of diabetic polyneuropathy. The literature data were analyzed, and information from articles was extracted and annotated using the PubMed biomedical research search engine for the effectiveness of drug and non­drug treatment of this problem. It has been established that adequate glycaemic control reduces the progression of complications, especially in type 1 diabetes mellitus. Clinical trials have not confirmed the effectiveness of pathogenetic therapy in mitigating the consequences of diabetes, so due to the lack of evidence, it is not yet advisable to recommend this range of drugs for the prevention of diabetes complications. The main disabling factor in diabetic polyneuropathy is neuropathic pain, which, in combination with microvascular complications, significantly worsens the patient’s quality of life. Anticonvulsants, antidepressants, and occasionally opioids remain the leaders among evidence­based drug therapies for neuropathic pain. Non­pharmacological therapy in the form of physical, mechanical, and chemical methods of influencing the human body, in particular the affected nerves, can be recommended as an addition to drug therapy to alleviate pain. This study is primarily intended for practitioners to familiarize them with the current international understanding of this problem and ways to combat it.