Long-Term Goals of Guidelines for Painful Diabetic Neuropathy: Brian Callaghan, MD, MS


The associate professor at the University of Michigan described the ways recently published guidelines on diabetic neuropathies will change how conditions like Guillain-Barré syndrome and CIDP are managed. [WATCH TIME: 3 minutes]

WATCH TIME: 3 minutes

"With [chronic inflammatory demyelinating polyneuropathy], the other piece is making sure that we have a good way of diagnosing people and putting [them] in the right category because otherwise you end up with a lot of overtreatment or undertreatment, which can cause a lot of problems."

First published in late 2021, a group of investigators convened to update the 2011 American Academy of Neurology guideline on painful diabetic neuropathy, with a focus on topical and oral medications and medical class effects.1 To do so, investigators, including senior author Brian Callaghan, MD, MS, systematically searched the literature for only Class I and II studies and prespecified 5 oral medication classes to evaluate. These included gabapentinoids, serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), sodium channel blockers, and SNRI/opioid dual mechanism agents (topiramate was not included as a sodium channel blocker because it has several mechanisms of action).

In the guidelines, the investigators noted that opioids should be strongly discouraged for situations of chronic noncancer pain. Additionally, for those treating painful diabetic neuropathy with tramadol and tapentadol, analgesic opioids, clinicians may offer the option of a safe tapering off from these medications and discuss alternative nonopioid treatment strategies. At the 2022 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, September 21-24, in Nashville, Tennessee, Callaghan delivered a talk on the updated guidelines, with the stress on why opioids should be avoided.

In an interview with NeurologyLive®, Callaghan, an associate professor at the University of Michigan discussed the long-term hopes for how these guidelines will shape clinical decisions and patient care moving forward. Additionally, he provided insight on the differences in approach for autoimmune neuropathies such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy (CIDP).

1. Price R, Smith D, Franklin G, et al. Oral and topical treatment of painful diabetic polyneuropathy: practice guideline update summary: report of the AAN guideline subcommittee. Neurology. 2022;98(1). doi:10.1212/WNL.0000000000013038
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