EVIDENCE-BASED GUIDELINE: TREATMENT OF PAINFUL DIABETIC NEUROPATHY-REPORT OF THE AMERICAN ASSOCIATION OF NEUROMUSCULAR AND ELECTRODIAGNOSTIC MEDICINE, THE AMERICAN ACADEMY OF NEUROLOGY, AND THE AMERICAN ACADEMY OF PHYSICAL MEDICINE & REHABILITATION
EVIDENCE-BASED GUIDELINE: TREATMENT OF PAINFUL DIABETIC NEUROPATHY-REPORT OF THE AMERICAN ASSOCIATION OF NEUROMUSCULAR AND ELECTRODIAGNOSTIC MEDICINE, THE AMERICAN ACADEMY OF NEUROLOGY, AND THE AMERICAN ACADEMY OF PHYSICAL MEDICINE & REHABILITATION
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DOI：
10.1002/mus.22092
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发表时间：
2011-06-01
期刊：
影响因子：
3.4
通讯作者：
Zochodne, Douglas W.
中科院分区：
文献类型：
--
作者：
Bril, Vera;England, John D.;Zochodne, Douglas W.
本报告的目的是为治疗疼痛性糖尿病神经病变 (PDN) 制定科学合理且临床相关的循证指南。提出的基本问题是：“特定治疗（药理学：抗惊厥药、抗抑郁药、阿片类药物等；非药理学：电刺激、磁场治疗、低强度激光治疗、灵气按摩等）对减轻 PDN 患者疼痛、改善身体功能和生活质量 (QOL) 的效果如何？”对 1960 年至 2008 年 8 月的文献进行了系统回顾，并根据美国神经病学学会治疗文章证据分类方案对研究进行了分类。建议与证据的强度相关。结果表明普瑞巴林被证实有效，应用于缓解 PDN（A 级）。文拉法辛、度洛西汀、阿米替林、加巴喷丁、丙戊酸、阿片类药物（硫酸吗啡、曲马多和羟考酮控释）和辣椒素可能有效，应考虑用于治疗 PDN（B 级）。其他治疗方法的证据不太有力，或者证据是否定的。 PDN 的有效治疗方法是可用的，但许多方法都有副作用，限制了它们的用途。很少有研究提供足够的信息来说明它们对功能和生活质量的影响。肌肉神经 43：910-917，2011
The objective of this report was to develop a scientifically sound and clinically relevant evidence-based guideline for the treatment of painful diabetic neuropathy (PDN). The basic question that was asked was: 'What is the efficacy of a given treatment (pharmacological: anticonvulsants, antidepressants, opioids, others; non-pharmacological: electrical stimulation, magnetic field treatment, low-intensity laser treatment, Reiki massage, others) to reduce pain and improve physical function and quality of life (QOL) in patients with PDN?' A systematic review of literature from 1960 to August 2008 was performed, and studies were classified according to the American Academy of Neurology classification of evidence scheme for a therapeutic article. Recommendations were linked to the strength of the evidence. The results indicate that pregabalin is established as effective and should be offered for relief of PDN (Level A). Venlafaxine, duloxetine, amitriptyline, gabapentin, valproate, opioids (morphine sulfate, tramadol, and oxycodone controlled-release), and capsaicin are probably effective and should be considered for treatment of PDN (Level B). Other treatments have less robust evidence, or the evidence is negative. Effective treatments for PDN are available, but many have side effects that limit their usefulness. Few studies have sufficient information on their effects on function and QOL. Muscle Nerve 43: 910-917, 2011