Changing the Treatment of Diabetic and Inflammatory Neuropathies: Brian Callaghan, MD, MS
The associate professor at the University of Michigan provided insight on new guidelines to treat painful diabetic neuropathy.
"Something like diabetic neuropathy isn’t talked about enough by people because it doesn’t usually lead to death or something super morbid; although, it can lead to amputations and things less common. What’s important about it is that it’s the most common neuropathy by far, and we have to pay attention to things that are super common, even if they’re not the worst diseases to have."
Despite the common occurrence of pain in patients with diabetic peripheral neuropathy, there remains a limited number of disease-modifying therapies available for treatment. For years, the first step to treating confirmed diabetic neuropathic pain included options such as tricyclic antidepressants (TCAs), serotonin-norepinephrine reuptake inhibitors (SNRIs), and voltage-gated calcium channel ligands. If these medications show a partial or no effect, clinicians typically try another first-line drug or a combination of first-line drugs, followed by opioids or tramadol.
At the 2022 American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) annual meeting, September 21-24, in Nashville, Tennessee, Brian Callaghan, MD, MS, gave a talk about the importance of treating painful diabetic neuropathy, and the need to change traditional treatment strategies. Callaghan, an associate professor at the University of Michigan, recommended using sodium channel blockers as a first-line treatment, and a combination of other first-line drugs, if a partial effect is observed. Additionally, he stressed other available options such as capsaicin and lidocaine, as well as other nonpharmacological approaches such as cognitive behavioral therapy, mindfulness, and exercise.
In an interview with NeurologyLive®, Callaghan provided insight on the reasons why he chose the topic, the most significant changes in treatment approaches, and why there is an urgent push to do away with opioids. He also discussed complexities with the diagnosis of painful neuropathies such as Guillain-Barré syndrome and chronic inflammatory demyelinating polyneuropathy.