Table 4.
Treatment algorithm for painful diabetic peripheral neuropathy (Toronto Consensus Panel on Diabetic Neuropathy)
| Painful diabetic neuropathy | |||
| First line | α2-δ agonist (pregabalin or gabapentin) | SNRI (duloxetine) | TCA |
| If pain control is inadequate and considering contraindications | |||
| Second line | TCA or SNRI | TCA or α2-δ agonist (pregabalin or gabapentin) | SNRI or α2-δ agonist (pregabalin or gabapentin) |
| If pain control is still inadequate | |||
| Third line | Add opioid agonist as combination therapy | ||
Note: Copyright © 2011, John Wiley and Sons. Adapted with permission from Tesfaye S, Vileikyte L, Rayman G, et al. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. 2011;27:629–638.72
Abbreviations: SNRI, serotonin–norepinephrine reuptake inhibitor; TCA, tricyclic antidepressant.