Management of painful diabetic neuropathy: guideline guidance or jungle?

The treatment of painful diabetic polyneuropathy (PDPN) remains a major challenge. A number of reasons have made the guidelines on PDPN management of particular interest, including its high prevalence, health and socioeconomic impact, interdisciplinary nature and the need for updated evidence-based information to refine patient-tailored treatment by weighing up the risks of each treatment against its proven benefits, as well as optimizing the use of all available resources. The various guidelines on the management of neuropathic pain developed so far contain some differences in their work methodology and results. Some variations in the recommendations are to be expected but could be disorienting and confusing for stakeholders. In this review, a critical evaluation of the more recent guidelines on the management of PDPN is provided together with highlights on points of agreement and disagreement as well as insights into their clinical aspects.