International Journal of Endocrinology

Review Article

Critical Appraisal of International Guidelines for the Management of Diabetic Neuropathy: Is There Global Agreement in the Internet Era?

Table 3

Recommendations regarding symptom management for painful neuropathy.
 DrugADAUMHSPNICEIDFAACENZGGAANTEPDNSFDSIGN*EFNSNICE*SADA
Antipyretic analgesics (AA)Acetaminophen—●———●1——○—●——
Tricyclic antidepressants (TCA)Amitriptyline●—●1●1●1●2●●1●1●●1●1●1
Nortriptyline—●1————○○●————
Imipramine—————●2○●1●●—●1●1
Desipramine—————●2○○●●—●1—
Clomipramine——○—————●1—●——
Antiepileptics (A)Pregabalin●●1●1●2●2●3●●1●1●●1●●
Gabapentin●●1●1●2●2●3●●1●1●●1●●2
Other antiepileptics (OA)Carbamazepine—●———●4—●○●○○●
Oxcarbazepine——○—●3—○—○—○○—
Valproate●●————●—○—○——
Topiramate——○———○●○—○—●
Lamotrigine——○———○—○—○——
SNRIs (S)Duloxetine●●1●1●2●1●●●1●1●●1●●
Venlafaxine●●○———●●—●●1——
Opiates (O)Tramadol●●●2●3●3—●●●2—●2●3●3
Morphine●—○———●●●—●●3—
Oxycodone●——●3——●●●2—●●3●3
Nonpharmacological interventionsTopical treatment—●●—●3●●●●○○—●
Physical therapy—●————●○●○——●
Combination therapiesTCA + S——○————●———●●2
TCA + A——○————●●2——●—
S + A——○————●—————
O + TCA + S——○————●———●—
O + TCA + A——○————●———●—
O + S + A——○————●—————
O + A——○—————●2●●——
O + AA—●○———————●——
O + TCA——○—————●2—●——
Referral to pain control team●4——●●4———————●4
● indicates being recommended; ○ indicates being not recommended; — indicates being not mentioned.
●1 indicates being recommended for first-line therapy; ●2 indicates being recommended for second-line therapy;
●3 indicates being recommended for third-line therapy; ●4 indicates being recommended for fourth-line therapy.
SNRI indicates serotonin noradrenaline reuptake inhibitor.
*The NICE and SIGN guidelines mentioned opiates, but no specific drugs were suggested.