AAN’s New Painful Diabetic Polyneuropathy Guidelines

A study entitled “Oral and Topical Treatment of Painful Diabetic Polyneuropathy: Practice Guideline Update Summary” was published on December 29, 2021, in the journal Neurology®. The Foundation for Peripheral Neuropathy (FPN) is pleased to announce that Lindsay Colbert, Executive Director, was among the few esteemed authors on the subcommittee for this important review and update.

Painful Diabetic Polyneuropathy: Study Overview

From January 2008 through April 2022, a group of medical professionals and Lindsay Colbert, a patient advocacy representative and Executive Director from FPN, systematically searched the literature using a structured review process to classify the evidence and develop practice recommendations using the American Academy of Neurology 2017 Clinical Practice Guideline Process Manual.

This study produced new results and guidelines that clinicians are encouraged to use while assessing and treating patients with painful diabetic neuropathies, including the preferred medications to be used and which drugs (opioids) should be avoided to treat painful symptoms stemming from neuropathy.

The results of the subcommittee’s findings and additional references can be found below.


The goal of this review was to update the 2011 American Academy of Neurology (AAN) guideline on the treatment of painful diabetic neuropathy (PDN) with a focus on topical and oral medications and medical class effects.


It was discovered during this review that gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRI), sodium channel blockers, and SNRI/opioid dual mechanism agents all have comparable effect sizes just above or just below the cutoff for a medium effect size. Tricyclic antidepressants (TCA) have a large effect size, but this result is tempered by a low confidence in the estimate.

Painful Diabetic Polyneuropathy: Recommendations Summary

Based on this study, it is recommended that clinicians should assess patients with diabetes for Peripheral Diabetic Neuropathy (PDN) and those with PDN for concurrent mood and sleep disorders. In patients with PDN, clinicians should offer TCAs, SNRIs, gabapentinoids, and/or sodium channel blockers to reduce pain and consider factors other than efficacy. Clinicians should offer patients a trial of medication from a different effective class when they do not achieve meaningful improvement or experience significant adverse effects with the initial therapeutic class and not use opioids for the treatment of PDN.

For further reading about this study, please visit the AAN Publications website. Or specifically read on about the following results:

Measure Specifications:

FPN Thanks the AAN

On behalf of FPN, we thank the AAN for taking this important study on and including our Executive Director in the review, to advocate on behalf of PN patients. We thank the esteemed medical professionals who co-authored this helpful publication.

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