Management of Neuropathic Pain in Polyneuropathy

Amanda C. Peltier, MD, MS; Derek Wood, MD Peripheral Nerve and Motor Neuron Disorders p. 1299-1322 October 2020, Vol.26, No.5 doi: 10.1212/CON.0000000000000928
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PURPOSE OF REVIEW Many polyneuropathies cause significant neuropathic pain, resulting in substantial morbidity and reduced quality of life. Appropriate management is crucial for maintaining quality of life for patients with painful polyneuropathies. The US Food and Drug Administration (FDA) has only approved one new drug for painful diabetic neuropathy in the past decade, a topical capsaicin patch that was initially approved for the treatment of postherpetic neuralgia in 2009. Gabapentinoids and serotonin norepinephrine reuptake inhibitors (SNRIs) continue to have an advantage in safety profiles and efficacy. Other antiepileptic medications remain second-line agents because of fewer studies documenting efficacy.

RECENT FINDINGS This article reviews recent literature on complementary and pharmacologic therapies for the management of painful polyneuropathies. Exercise has emerged as an important therapeutic tool and may also improve the underlying polyneuropathy in the setting of obesity, metabolic syndrome, and diabetes.

SUMMARY The approach to management of painful polyneuropathies is multifactorial, using both pharmacologic and nonpharmacologic measures to improve pain severity and patient quality of life.

Address correspondence to Dr Amanda C. Peltier, Vanderbilt University Medical Center, A-0118 Medical Center North, Nashville, TN 37232, Amanda.peltier@vumc.org.

RELATIONSHIP DISCLOSURE: Dr Peltier serves as secretary for the International Diabetes Neuropathy Consortium, on the board of directors of the American Autonomic Society, and on advisory boards for Akcea Therapeutics; Alnylam Pharmaceuticals, Inc; and CSL Behring. Dr Peltier has received personal compensation for speaking engagements from Akcea Therapeutics and CSL Behring and research/grant support from Akcea Therapeutics; CSL Behring; and the National Institute of Neurological Disorders and Stroke NeuroNEXT. Dr Wood reports no disclosure.

UNLABELED USE OF PRODUCTS/INVESTIGATIONAL USE DISCLOSURE: Drs Wood and Peltier discuss the unlabeled/investigational use of α-lipoic acid, amitriptyline, cannabidiol oil, carbamazepine, nortriptyline, oxcarbazepine, spinal cord stimulators, valproic acid, and venlafaxine for the treatment of neuropathic pain in polyneuropathy.

© 2020 American Academy of Neurology.