What are the AAN/AANEM/AAPMR guidelines for topical treatment used for painful diabetic neuropathy (PDN)?

Updated: Jan 17, 2020
  • Author: Dianna Quan, MD; Chief Editor: Romesh Khardori, MD, PhD, FACP  more...
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Topical therapy with capsaicin or transdermal lidocaine may be useful in some patients, especially those with more localized pain or those in whom interactions with existing oral medications is a concern. The 2011 AAN/AANEM/AAPMR guideline recommends that both of these agents be considered in for treatment of PDN. In clinical trials, capsaicin has been effective in reducing pain in PDN, but many patients cannot tolerate the side effects, such as burning pain on contact with warm/hot water or in hot weather. Any of these medications may be associated with adverse effects, and patients should be counseled about possible problems before initiating treatment. [84, 63] Patients should be assessed every 6 weeks so that adverse effects can be monitored if possible. Decrease or increase drug dose if indicated.

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