Distal symmetric polyneuropathy (DSP) is the most common type of peripheral nerve neuropathy, and occurs in around 15% of individuals over 40 years of age, and affects approximately 30% of diabetes patients. In addition to diabetes, obesity is also a significant DSP risk factor.
The authors reviewed the current status of our understanding of DSP in 2020, highlighting current diagnostic methods and, importantly, managing neuropathic pain, which is frequently present in individuals with DSP. Neuropathic pain remains hard to manage, even in 2020, and physicians need to avoid prescribing addictive opioids and be cognizant of out-of-pocket costs to the patient. This review outlines a layered treatment protocol for neuropathic pain in DSP that promotes first-, second-, third-, and fourth-line treatments that circumvent opioid use.