Sertbas et al.2222 Sertbas M, Sertbas Y, Uner OZ, Elarslan S, Okuroglu N, Lens FAK, et al. Autoflorescence ratio as noninvasive marker of peripheral diabetic neuropathy. Pol Arch Intern Med. 2019;129(3):175-80. USA |
Investigate fluorescence as a treatment method based on the diagnosis of DN and neuropathic pain in DM. |
Randomized clinical trial. 160 patients. Pain was assessed by DN4 to investigate the effectiveness of treatment. 1B |
DN4 has very effectively detected fluorescence treatment for DN and neuropathic pain. |
Alexander et al.2323 Alexander J Jr, Edwards RA, Brodsky M, Manca L, Grugni R, Savoldelli A, et al. Using time series analysis approaches for improved prediction of pain outcomes in subgroups of patients with painful diabetic peripheral neuropathy. PLoS One. 2018;13(12):e0207120. Germany |
To evaluate the treatment of neuropathic pain with pregabalin using pain scales. |
Review of clinical studies. 1766patients. Pain evaluated by BPI and DN4 with pregabalin treatment. 1B |
30 to 50% of people evaluated with BPI and DN4 achieved improvement with pregabalin. |
Selvarajah et al.2424 Selvarajah D, Petrie J, White D, et al. Multicentre, double-blind, crossover trial to identify the Optimal Pathway for TreatIng neurOpathic paiN in Diabetes Mellitus (OPTION-DM): study protocol for a randomised controlled trial. Trials. 2018;19(1):578. Europe |
Determine the best treatment route for neuropathic pain. Amitriptyline and/or pregabalin. |
Clinical study with 392 patients. Pain assessment by NRS after 7 days and 6 weeks of treatment with amitriptyline and/or pregabalin. 1B |
After evaluation, the treatment can be complementary to both drugs: amitriptyline and pregabalin |
Marcus et al.2525 Marcus J, Lasch K, Wan Y, Yang M, Hsu C, Merante D. An Assessment of clinically important differences on the worst pain severity item of the modified Brief Pain Inventory in patients with diabetic peripheral neuropathic pain. Pain Res Manag. 2018;2018:2140420. USA |
To observe the clinical difference of evolution of neuropathic pain in DM. |
Clinical study with 452 patients evaluated with BPI in 5 weeks of conventional treatment for neuropathic pain. 1B |
BPI identified clinical improvement in most patients evaluated with conventional treatment for neuropathic pain. |
Ahn et al.2626 Ahn AC, Bennani T, Freeman R, Hamdy O, Kaptchuk TJ. Two styles of acupuncture for treating painful diabetic neuropathy--a pilot randomised control trial. Acupunct Med. 2007;25(1-2):11-7. Boston |
To evaluate the clinical and mechanistic effects of Chinese and Japanese acupuncture on painful DN. |
Randomized study. Acupuncture performed once a week for 10 weeks. Pain was assessed using the McGill Short Form Pain questionnaire (SF-MPQ). 1B |
Clinically, patients allocated to Japanese acupuncture reported decreased pain associated with neuropathy, while the group allocated to traditional acupuncture reported minimal effects. |
Van Nooten et al.2727 Van Nooten F, Treur M, Pantiri K, Stoker M, Charokopou M. Capsaicin 8% patch versus oral neuropathic pain medications for the treatment of painful diabetic peripheral neuropathy: a systematic literature review and network meta-analysis. Clin Ther. 2007;39(4):787-803.e18. USA |
To evaluate sleep and neuropathic pain in DN by treatment with 8% capsaicin. |
Randomized study. Patients were assessed through pain scales and a scale to assess sleep quality with capsaicin 8%. 1B |
The improvement of pain from the proposed treatment was evidenced by means of low scores attributed to the BPI pain scale. |
Garoushi, Johson and Tashani2828 Garoushi S, Johson MI, Tashani OA. Translation and cultural adaptation of the Leeds Assessment of Neuropathic Symptoms and Signs (LANSS) pain scale into Arabic for use with patients with diabetes in Libya. Libyan J Med. 2017;12(1):1384288. Líbya |
Develop an Arabic version of the LANSS scale and evaluate its validity and reliability in diabetic patients in Benghazi, Libya. |
Cross-sectional study on translation and validation of LANSS for Arabic. Simultaneous validity was tested and compared with the self-completed LANSS assessment of neuropathic symptoms and signs (S-LANSS). 2B |
It was concluded that the Arabic version of the LANSS pain scale was valid and reliable for use in diabetic patients in Libya. |
Barbosa et al.2929 Barbosa M, Saavedra A, Severo M, Maier C, Carvalho D. Validation and reliability of the Portuguese version of the Michigan Neuropathy Screening Instrument. Pain Pract. 2016;17(4): 514-21. Portugal |
Validate the translation into Portuguese of the MNSI questionnaire in diabetic patients. |
Cross-sectional study. 76 diabetic patients underwent evaluation of the presence of DN by MNSI translated into Portuguese. 2B |
The MNSI in the Portuguese version is reliable and a valid tool for detecting DN. |
Chevtchouk, Silva and Nascimento3030 Chevtchouk L, Silva MHSD, Nascimento OJMD. Ankle-brachial index and diabetic neuropathy: study of 225 patients. Arqu Neuropsiquiatr. 2017;75(8):533-8. Brazil |
Assess neuropathic pain and peripheral vascular disease in diabetics and compare it with time to diagnosis of type 1 diabetes (DM 1) and type 2 diabetes (DM 2). |
Cross-sectional study with 225 individuals with diabetes evaluated by the DN4 questionnaire and the ankle-brachial index (ABI). 2B |
There was a predominance of neuropathic pain in patients over 60 years of age with an ABI> 1.3. The neuropathic pain diagnosed by DN4 was related to abnormal ABI in 64.2% of the patients. |
Salcini et al.3131 Salcini C, Atasever-Arslan B, Sunter G, Gur H, Isik FB, Saylan CC. High plasma pentraxin 3 levels in diabetic polyneuropathy patients with nociceptive pain. Tohoku J Exp Med. 2016;239(1):73-9. Oxford |
To measure the plasma levels of PTX3 and TBP2 in patients with DM2 with complaints of pain. |
Clinical trial. Plasma levels of PTX3 and TBP2 were measured in patients with DM2 and pain and their levels compared to healthy individuals using LANNS for pain assessment. 1B |
Plasma levels of PTX3 may be useful for discriminating nociceptive pain from neuropathic pain in diabetic patients, assessed using the LANNS scale. |
Kelle et al.3232 Kelle B, Evran M, Balli T, Yavuz F. Diabetic peripheral neuropathy: correlation between nerve cross-sectional area on ultrasound and clinical features. J Back Musculoskelet Rehabil. 2016;29(4):717-22. USA |
To evaluate the cross-sectional area (CSA) correlations of the peripheral nerves in patients with PDN. |
Clinical trial. The CSA was evaluated in a group of patients with painful DN (n = 53) and a control group (n = 53). The CSAs of the nerves were recorded, and their associations with pain intensity according to the VAS numeric pain score and the LANSS pain scale score were evaluated. 1B |
No correlations were detected between the CSAs of the nerves examined and the parameters of interest. |
Hotta et al.3333 Hotta N, Kasuga M, Kashiwagi A, Kawamori R, Yamada T et al. Efficacy and safety of 40 mg or 60 mg duloxetine in Japanese adults with diabetic neuropathic pain: results from a randomized, 52-week, open-label study. J Diabetes Investig. 2016;7(1):100-8. Japan |
To examine the long-term efficacy and safety of duloxetine in the treatment of Japanese patients with diabetic neuropathic pain. |
Randomized, controlled, double-blind trial. 258 Japanese adults with DN and pain were used to test the dose of 40 mg / day or 60 mg / day of duloxetine for 52 weeks of treatment. The pain was evaluated through the BPI 1B |
There was significant improvement in pain with treatment. The use of duloxetine resulted in significant improvement of pain assessed by BPI. |
Papp et al.3434 Papp, GR, George MC, Dorfman D, Simpson DM. Barriers to chronic pain measurement: a qualitative study of patient perspectives. Pain Med. 2015;16(7):1256-64. Nova York |
To test instruments for the evaluation of pain in DN and chronic low back pain in patients with HIV. |
Cross-sectional study. Participants were divided into three focus groups based on their pain condition. The following instruments were tested: VAS, Bref Pain Inventory and SF-MPQ. 2B |
These instrument themes are relevant for understanding the properties of validity and scale of commonly used pain intensity measures. |
Mathieson et al.3535 Mathieson S, Maher CG, Terwee CB, Folly de Campos T, Lin CW. Neuropathic pain screening questionnaires have limited measurement properties. A systematic review. J Clin Epidemiol. 2015;68(8):957-66. Austrália |
To evaluate the psychometric properties of the questionnaires DN4, ID Pain, LANSS, PainDETECT and Neuropathic Pain Questionnaire. |
Systematic review of the literature. 1A |
DN4 and Neuropathic Pain Questionnaire were more suitable for clinical use. Screening questionnaires should not replace a complete clinical evaluation. |
Gao et al.3636 Gao Y, Guo X, Han P, Li Q, Yang G, Qu S, et al. Treatment of patients with diabetic peripheral neuropathic pain in China: a double-blind randomised trial of duloxetine vs. placebo. Int J Clin Pract. 2015;69(9):957-66. China |
To assess the efficacy and safety of duloxetine (60 mg once daily) in Chinese individuals with DN. |
Randomized clinical trial. 405 patients were divided into two groups and evaluated by MNSI, and those with a score of ≥ 4 were evaluated with BPI to quantify the mean weekly pain intensity. 1B |
Patients treated with duloxetine had significantly greater pain relief compared to placebo-treated patients, according to the instruments. |
Bramson et al.3737 Bramson C, Herrmann DN, Carey W, Keller D, Brown MT, West CR, et al. Exploring the role of tanezumab as a novel treatment for the relief of neuropathic pain. Pain Med. 2015;16(6):1163-76. USA |
To assess the efficacy and safety of tanezumab, against nerve growth factor, in neuropathic pain in patients with diabetes. |
Clinical trial. One group of patients received intravenous tanezumab 50µg/kg or 200µg/kg and another group received placebo. Assessments included baseline change in mean daily pain (primary endpoint) and BPI. 1B |
Tanezumab provided effective reduction of pain. |
Kessler et al.3838 Kessler JA, Smith AG, Cha BS, Choi SH, Wymer J, Shaibani A, et al. Double-blind, placebo-controlled study of HGF gene therapy in diabetic neuropathy. Ann Clin Transl Neurol. 2015;2(5): 465-78. USA |
To evaluate the safety and efficacy of a plasmid (VM202) given by intramuscular injections in patients with DN pain. |
Clinical trial, double blind. Patients were randomized to receive 8 or 16 mg injections of VM202 or placebo. Divided doses were administered on Day 0 and Day 14. Pain was assessed by BPI and MNSI. 1B |
Through treatment with VM202, There was a significant improvement in pain with the evaluation of the BPI and MNSI instruments. |
Celik et al.3939 Celik S, Yenidunya, Temel E, Purisa S, Uzum AK, Gul N, Cinkil G, et al. Utility of DN4 questionnaire in assessment of neuropathic pain and its clinical correlations in Turkish patients with diabetes mellitus. Prim Care Diabetes. 2016;10(4): 259-64. Istambul |
To evaluate the usefulness of the DN4 questionnaire to define the frequency and severity of neuropathic pain and its correlation with clinical practice in diabetic polyneuropathy. |
Cross-sectional study. The presence of neuropathic pain was assessed by the DN4 questionnaire and by physical sensitivity examination. Those with a DN4 score ≥4 were considered to have neuropathic pain. 2B |
The use of the DN4 questionnaire in daily clinical practice is an effective tool to detect the presence of neuropathic pain in patients with polyneuropathy. |
De Vos et al.4040 de Vos CC, Meier K, Zaalberg PB, Nijhuis HJ, Duyvendak W, Vesper J, Enggaard TP, Lenders MW. Spinal cord stimulation in patients with painful diabetic neuropathy: a multicentre randomized clinical trial. Pain. 2014;155(11):2426-31. Netherlands |
To investigate whether there is efficacy in spinal cord stimulation (SCS) in patients with DN and pain. |
Randomized clinical trial. Two groups: one of clinical practice with SCS and another control group. Both were evaluated with EuroQoL 5D, McGill Pain Questionnaire (MPQ) and VAS to measure pain intensity. 1B |
SCS improved patients' pain and quality of life according to the scales used. |
Agrawal et al.4141 Agrawal RP, Jain S, Goyal S, Singhal S, Lindgren L, Sthengel E. A clinical trial of nitrosense patch for the treatment of patients with painful diabetic neuropathy. J Assoc Physicians India. 2014;62(5):385-90. USA |
To evaluate the efficiency of Nitro Sense Derma Protect as a source of nitric oxide (NO) for patients with painful DN. |
Randomized clinical trial. Divided in 2 groups: placebo and treatment (24 mg for 3 hours, every day for a period of 3 weeks). Pain was assessed by VAS and SF-MPQ. 1B |
NitroSense Derma Protect treatment controls painful DN. |
Dobrota et al.4242 Dobrota VD, Hrabac P, Skegro D, Smiljanic R, Dobrota S, Prkacin I, et al. The impact of neuropathic pain and other comorbidities on the quality of life in patients with diabetes. Health Qual Life Outcomes. 2014;3(12):171. Croatia |
To identify how neuropathic pain in diabetic patients interferes with their quality of life |
Cross-sectional study. 80 patients were evaluated by the VAS, LANNS, SF-36 and BDI scales. 2B |
Pain in diabetics is an important factor that influences quality of life. |
Freeman et al.4343 Freeman R, Baron R, Bouhassira D, Cabrera J, Emir B. Sensory profiles of patients with neuropathic pain based on the neuropathic pain symptoms and signs. Pain. 2014;155(2):367-76. USA |
To characterize the clinical profile of various neuropathic pain disorders and to identify whether the patterns of sensory symptoms / signs exist. |
Clinical trial. The Neuropathic Pain Symptom Inventory (NPSI) and quantitative sensory tests (QST) were used for evaluation. Based on 4 previous clinical trials 1B |
Based on the NPSI identified 3 dimensions of pain: triggered, deep, and punctual. Based on the signs of QST, 2 dimensions of pain were identified: evoked by cold and evoked by touch. |
Hamdan et al.4444 Hamdan A, Luna JD, Del Pozo E, Galvez R. Diagnostic accuracy of two questionnaires for the detection of neuropathic pain in the Spanish population. Eur J Pain. 2014;18(1):101-9. Spain |
To compare the diagnostic accuracy of LANSS and DN4 for the detection of peripheral neuropathic pain in the Spanish population. |
Cross-sectional study. 192 patients were evaluated, comparing the validity of the DN4 and LANSS questionnaires, studying sensitivity and specificity, and using the receiver operator characteristic curve ROC analysis. 2B |
The sensitivity of the DN4 questionnaire was 95.04% and that of the LANSS questionnaire was 80.17%. The specificity of the DN4 instrument was 97.18% and that of the LANSS instrument was 100%. The area under the ROC curve was significantly higher for the DN4 than the LANSS questionnaire (p <0.05). |
Pedras, Carvalho and Pereira4545 Pedras S, Carvalho R, Pereira MG. Caracteristicas sociodemograficas e clinicas de doentes com pe diabetico. Rev Assoc Med Bras. 2016;62(2):171-8. Portugal |
To characterize in a sociodemographic and clinical manner the patients with diabetic ulcer indicated for amputation surgery. |
Cross-sectional study. 206 patients were evaluated. Sociodemographic and clinical characteristics, pain intensity and pain interference were evaluated by Bref Pain Inventory and DN4. 2B |
About 59% of patients experienced pain in the lower limb that significantly interfered in all areas of their functioning. |
Ziegler et al.4646 Ziegler D, Schneider E, Boess FG, Berggren L, Birklein F. Impact of comorbidities on pharmacotherapy of painful diabetic neuropathy in clinical practice. J Diabetes Complications. 2014;28(5):698-704. Germany |
To evaluate the effect of duloxetine and anticonvulsants in patients with painful DN. |
Randomized clinical trial. A total of 2,575 patients with painful DN were treated for 6 months and the results from BPI assessment for pain scores were observed. 1B |
41.5% of the patients reported chronic pain and improvement through duloxetine and anti-convulsive treatment when comparing BPI pain scores. |
Ajroud-Driss et al.4747 Ajroud-Driss S, Christiansen M, Allen JA, Kessler JA. Phase 1/2 open-label dose-escalation study of plasmid DNA expressing two isoforms of hepatocyte growth factor in patients with painful diabetic peripheral neuropathy. Mol Ther. 2013;21(6):1279-86. USA |
To assess the safety and efficacy of intramuscular injections of plasmid DNA (VM202) in patients with PDN. |
Cohort study. 12 Patients received two sets of injections for 2 weeks. Safety was assessed through pain scales: VAS, SF-MPQ, BPI. These instruments measured the pain again for 12 months. 2B |
The results with BPI-PDN and SF-MPQ showed similar patterns to VAS scores, thus demonstrating efficiency in treatment with injections in painful DN. |
Lee et al.4848 Lee S, Kim JH, Shin KM, Kim JE, Kim TH, Kang KW, et al. Electroacupuncture to treat painful diabetic neuropathy: study protocol for a three-armed, randomized, controlled pilot trial. Trials. 2013;18(14):225. USA |
To evaluate the effectiveness of electroacupuncture in the treatment of DN. |
Randomized, controlled, double-blind study. 45 patients with more than 6 months of painful DN, with pain intensity greater than 4 per BPI were evaluated. They were divided into three intervention groups for 30 minutes for 8 weeks. 1B |
From the pain scale, it was possible to observe improvement of pain and effectiveness of electroacupuncture. |
Spallone et al.4949 Spallone V, Morganti R, D'Amato C, Greco C, Cacciotti L, Marfia GA. Validation of DN4 as a screening tool for neuropathic pain in painful diabetic polyneuropathy. Diabet Med. 2013;29(5):578-85. USA |
To evaluate the validity and diagnostic accuracy of the DN4 interview in the identification of neuropathic pain of diabetic polyneuropathy. |
Cross-sectional study. 158 patient's diabetic polyneuropathy and neuropathic pain was assessed using DN4, nerve conduction studies, history of pain, VAS and SF-MPQ. 2B |
The DN4 interview scores showed high diagnostic precision for painful diabetic polyneuropathy, with sensitivity of 80% and specificity of 92%, being a reliable screening tool for diabetic polyneuropathy pain. |
Walsh, Rabey and Hall et al.5050 Walsh J, Rabey MI, Hall TM. Agreement and correlation between the self-report leeds assessment of neuropathic symptoms and signs and Douleur Neuropathique 4 Questions neuropathic pain screening tools in subjects with low back-related leg pain. J Manipulative Physiol Ther. 2012;35(3):196-202. Ireland |
To assess the similarity between LANNS and DN4 in the identification of neuropathic pain. |
Cross-sectional study. 45 patients were evaluated to observe the occurrence of neuropathic pain through the mentioned scales, being used to compare the Pearson coefficient. 2B |
Neuropathic pain was identified in 33% by LANNS and 42% by DN4. The conclusion is that the two questionnaires are congruent in the evaluation. |
Kluding et al.5151 Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, et al. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications. 2012;26(5):424-9. Canada |
To examine the feasibility and efficacy of a moderately intense aerobic and resistance exercise program in people with painful DN. |
Cross-sectional study. 17 people with painful DN performed aerobic exercises and strengthening for 10 weeks. Outcome measures included VAS scales, MNSI, nerve function measures and intraepidermal nerve fiber density, and branching in distal and proximal lower extremity cutaneous biopsies. 2B |
After supervised exercise, improvement in nerve function and branching was detected, as well as improvement in MNSI and VAS. |
Adelmanesh et al.5252 Adelmanesh F, Jalali A, Attarian H, Farahani B, Ketabchi SM, Arvantaj A, et al. Reliability, validity, and sensitivity measures of expanded and revised version of the short-form McGill Pain Questionnaire (SF-MPQ-2) in Iranian patients with neuropathic and non-neuropathic pain. Pain Med. 2012;13(12):1631-6. Persia |
To assess the validity, reliability, and sensitivity of the Persian version of the MPQ in patients with neuropathic and non-neuropathic pain. |
Transversal study. 184 patients with subacute and chronic non-neuropathic pain and 74 patients with PDN with pain participated in the study and responded to the questionnaire. 2B |
The Persian translation of the expanded and revised version of the MPQ is a highly reliable, sensitive and valid instrument for assessing pain in patients with or without neuropathic etiology. |
Searle, Bennett and Tennant5353 Searle RD, Bennett MI, Tennant A. Can neuropathic screening tools be used as outcome measures? Pain Med. 2011;12(2):276-81. Ukraine |
Examine whether the LANSS selection tool can meet the expectations of the Rasch model. |
Retrospective study. Original LANSS data from a previous study of 2,480 patients with chronic pain were used. The following assessments have been made and adapted to the model for reliability of scale and functionality. 2C |
The analysis shows that LANSS can be used in specific populations of patients with neuropathic pain. |
Erbas et al.5454 Erbas T, Ertas M, Yucel A, Keskinaslan A, Senocak M. Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients. J Clin Neurophysiol. 2011;28(1):51-5. Turkey |
To determine the prevalence of PDN and neuropathic pain in patients attending university outpatient clinics in Turkey. |
Cross-sectional multicenter. A total of 1113 patients were evaluated through clinical neurological examinations through LANSS and nerve conduction. 2B |
DN coadjusted 40.4% of the patients and the prevalence of neuropathic pain in the population of diabetic patients was 14.0%, according to the scale evaluated. |
Abbott et al.5555 Abbott CA, Malik RA, Van Ross ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34(10):2220-4. England |
To evaluate, in the diabetic population in general, the prevalence of symptoms of painful neuropathy, the relationship between symptoms and clinical severity of neuropathy, as well as relating gender and ethnicity. |
Observational cohort. 15692 people with DM in England were evaluated using a neuropathy symptom score (NSS) and neuropathy disability score (NDS). 2B |
Painful symptoms occurred in 26% of patients without neuropathies and 60% of patients with severe neuropathy, with a higher risk in females, smokers and alcoholics. |
Hoffman et al.5656 Hoffman DL, Sadosky A, Dukes EM, Alvir J. How do changes in pain severity levels correspond to changes in health status and function in patients with painful diabetic peripheral neuropathy? Pain. 2010;149(2):194-201. USA |
To compare changes in pain, function and health status in individuals with PDN with pregabalin treatment. |
Randomized controlled. 401 patients were included in the 12-week pregabalin treatment and the groups were compared through the BPI and EuroQoL 5D pain scales. 1B |
A reduction of 30% served as determinant of a clinically important difference, through the results of pain scales. |
Petrikonis et al.5757 Petrikonis K, Sciupokas A, Samusyte G, Janušauskaitė J, Sulcaite R, Vaitkus A. Importance of pain evaluation for more accurate diagnosis of painful diabetic polyneuropathy. Medicina. 2010;46(11):735-42. Lituania |
To evaluate the neuropathic pain profile and its association with quantitative sensorial tests in diabetic painful polyneuropathy. |
Cross-sectional study. 61 patients were evaluated by clinical neurological exams and quantitative sensory tests. Patients were interviewed using the Neuropathic Pain Scale (NPS) and MPQ. 2B |
The intensity of the deep and superficial pain did not differ, but the patients rated the deep pain as more unpleasant. |
Moreira et al.5858 Moreira RO, Amancio AP, Brum HR, Vasconcelos DL, Nascimento GF. Depressive symptoms and quality of life in type 2 diabetic patients with diabetic distal polyneuropathy. Arq Bras Endocrinol Metabol. 2009;53(9):1103-11. Brazil |
To evaluate the impact of depressive symptoms and neuropathic pain on the quality of life of patients with diabetic distal polyneuropathy. |
Cross-sectional study. 204 patients with type 2 diabetes with polyneuropathy were evaluated by the Neuropathic Symptom Score and Neuropathic Compromise Score. Severity of neuropathic pain was assessed by VAS; depressive symptoms, through the Beck Depression Inventory (BDI); and quality of life through the World Health Organization Quality of Life abbreviated scale (Whoqol-bref). 2B |
Depression and quality of life are fully linked to the severity of pain in diabetic polyneuropathy. |
Scherens et al.5959 Scherens A, Maier C, Haussleiter IS, Schwenkreis P, Vlckova-Moravcova E, Baron R, et al. Painful or painless lower limb dysesthesias are highly predictive of peripheral neuropathy: comparison of different diagnostic modalities. Eur J Pain. 2009;13(7):711-8. Germany |
Investigate the prevalence and type of neuropathy and compare the performance of the diagnosis. |
Prospective study. 42 patients underwent a clinical examination, nerve conduction studies, Quantitative Sensory Tests (QST) and skin biopsy on the dorsum of the foot. Most patients (> 90%) had signs of small fiber loss or dysfunction. 2C |
All patients with DN should complement their diagnosis with Skin biopsy. |
Dworkin et al6060 Dworkin RH, O'Connor AB, Audette J, Baron R, Gourlay GK, Haanpaa ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3):S3-14. USA |
To develop a single measure of the main symptoms of neuropathic and non-neuropathic pain that can be used in studies of epidemiology, natural history, pathophysiological mechanisms and response to treatment. |
Clinical trial. The SF-MPQ pain descriptors have been expanded and revised, adding to the relevant symptoms for neuropathic pain performed by an Assay based on longitudinal studies and clinical trials in 882 patients. 1B |
The data suggest that SF-MPQ has excellent reliability and validity. |
Tavakoli et al6161 Tavakoli M, Asghar O, Alam U, Petropoulos LN, Fadavi H, Malik,RA. Novel insights on diagnosis, cause and treatment of diabetic neuropathy: focus on painful diabetic neuropathy. Ther Adv Endocrinol Metab.2010; 1(2):69-88. United Kingdom |
Define sensitive diagnostic tests for DN to better evaluate the implementation of interventions for painful DN. |
Systematic review. Identify placebo treatments for PDN after BPI, QST, MPQ, DN4 and NPS assessment. 1A |
Specific diagnostic tests for painful DN are important to detect better treatment results. |
Crawford et al.6262 Crawford B, Bouhassira D, Wong A, Dukes E. Conceptual adequacy of the neuropathic pain symptom inventory in six countries. Health Qual Life Outcomes. 2008;6:62. USA |
Determine whether the Inventory of Pain Symptoms (PNS) adequately assess patient with neuropathic pain and DN. |
Qualitative Study. Tests were carried out in 6 countries to observe the cultural adaptation associated with neuropathic symptoms. 2B |
Based on the study, this instrument can be used alternatively in the evaluation of neuropathic pain in all countries observed. |
Veves et al6363 Veves A, Backonja M, Malik RA. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med. 2008(9):660-74. USA |
Describe the epidemiology, pathophysiology, diagnosis and treatment for painful DN from 1997 to 2007. |
Systematic review. Quantifying neuropathic pain is difficult, especially for clinical trials, although this has improved recently with the development of neuropathic pain-specific tools, such as the Neuropathic Pain Questionnaire and the Neuropathic Pain Symptom Inventory. 1A. |
Best treatment results can be achieved through the specific diagnosis by Neuropathic Pain Scale (NPS), MPQ and BPI. |
Armstrong et al.6464 Armstrong DG, Chappell AS, Le TK, Kajdasz, DK, Backonja M, D'Souza DN, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evaluation of functional outcomes. Pain Med. 2007;8(5):410-8. USA |
To evaluate the efficacy of duloxetine in the treatment of PDN pain. |
Multicentric study. Treatment was reactivated with duloxetine 20 mg once daily, 60 mg twice daily or placebo. The groups were divided randomly. Functional results reported by the patient were measured by Short Form 36 (SF-36), the interference portion of BPI and EuroQol 5D Health Questionnaire (EQ-5D). |
Through the instruments used, it was observed that the treatment with duloxetine was significantly superior to placebo in all domains. |