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1、TreatmentofPainfulDiabeticNeuropathyReportoftheAmericanAcademyofNeurology,theAmericanAssociationofNeuromuscularandElectrodiagnosticMedicine,andtheAmericanAcademyofPhysicalMedicineandRehabilitationVeraBril,MD,FRCP(C);JohnEngland,MD,FAAN;GaryM.Franklin,MD,MPH,FAAN;MiroslavBackonja,MD;Jef
2、freyCohen,MD,FAAN;DavidDelToro,MD;EvaFeldman,MD,PhD,FAAN;DonaldJ.Iverson,MD,FAAN;BrucePerkins,MD,FRCP(C),MPH;JamesW.Russell,MD,MS,FRPC;DouglasZochodne,MDIfyouhavequestions,comments,orfeedbackregardingthisslidepresentation,orwouldliketomodifythecontentsforpresentationinalecture,pleaseco
3、ntactguidelines@aan.comPresentationObjectivesTopresentanalysisoftheefficacyofpharmacologicandnonpharmacologictreatmentstoreducepainandimprovephysicalfunctionandqualityoflife(QOL)inpatientswithpainfuldiabeticneuropathy(PDN)Topresentevidence-basedrecommendationsOverviewBackgroundGapsinca
4、reAmericanAcademyofNeurology(AAN)guidelineprocessAnalysisofevidence,conclusions,recommendationsRecommendationsforfutureresearchBackgroundDiabeticsensorimotorpolyneuropathyrepresentsadiffusesymmetricandlength-dependentinjurytoperipheralnervesthathasmajorimplicationsforQOL,morbidity,andc
5、ostfromapublichealthperspective.1,2PDNaffects16%ofpatientswithdiabetes;itisfrequentlyunreported(12.5%)andmorefrequentlyuntreated(39%).3PDNpresentsanongoingmanagementproblemforpatients,caregivers,andphysicians.Manytreatmentoptionsareavailable,andarationalapproachtotreatingpatientswithPD
6、Nrequiresanunderstandingoftheevidenceforeachintervention.ThisguidelineaddressestheefficacyofpharmacologicandnonpharmacologictreatmentstoreducepainandimprovephysicalfunctionandQOLinpatientswithPDN.Background,cont.PharmacologicAgents:Anticonvulsants,antidepressants,opioids,antiarrhythmic
7、s,cannabinoids,aldosereductaseinhibitors,proteinkinaseCbetainhibitors,antioxidants(α-lipoicacid),transketolaseactivators(thiaminesandallithiamines),topicalmedications(analgesicpatches,anestheticpatches,capsaicincream,clonidine),andothersNonpharmacologicModalities:Infraredtherapy,shoe
