Treatment of painful diabetic neuropathy.

P neuropathy is one of the commonest long term complications of diabetes mellitus which has been reported to be prevalent in 22% of d iabe t i c cohor t . 1 Pa in fu l d iabe t i c neuropathy (PDN) occurs in 6% of the patients with diabetic peripheral neuropathy (DPN) and this is most distressing symptom which impairs quality of life.2 Patients seek advice to get relief but unfortunately treatment has been inadequate. Mechanisms of PDN involve many biological, structural and electrophysiological alterations of nervous tissues. They can be enlisted asA. Pe r i p h e r a l m e c h a n i s m s w h i c h include changes in sodium channel distribution and expression, changes in calcium channel distribution and expression, a l tered neuropeptide expression, sympathetic sprouting, loss of spinal inhibitory control, altered peripheral blood flow, axonal atrophy, degeneration, or regeneration, damage to small fibres and increased glycaemic flux.3 B. Central mechanisms which include, Central sensitisation, changes in the balance of facilitation/inhibition within descending pathways and increased thalamic vascularity. Myriad of pathogenetic mechanisms of PDN is a challenge to develop a drug that can be definitive treatment to alleviate miseries of the condition. I t is a lso not certain which of the mechanisms i s over t ly media t ing the pain in one individual. Several pharmacological treatments have been proved effective in the management of painful PDN to certain extent. It is efficacy and safety that is considered while choosing pharmacological agents. Many times, a principle of “hit trial” help selection of the drug for PDN. Treatment of Painful Diabetic Neuropathy