Diabetic peripheral neuropathy: a systematic review of current interventional pain management strategies

Diabetic peripheral neuropathy (DPN) is characterized by pain, tingling, and numbness due to nerve damage caused by diabetes. DPN is a prevalent complication of diabetes, marked by sensations of pain and sensory deficits. Effective pain management strategies are critical to improve patient quality of life. This review follows the preferred reporting items for systematic reviews and meta-analyses guidelines, using the population, intervention, control, and outcome study framework to select studies evaluating interventional treatments for DPN. We conducted an exhaustive literature search from January 1990 to March 2024 using PubMed, Cochrane, Google Scholar, Scopus and MEDLINE databases, applying relevant medical subject heading terms. An independent reviewer assessed the selected studies based on outcome parameters such as pain relief, sleep quality, analgesic usage, functional improvement, and quality of life. Interventions like transcutaneous electrical nerve stimulation (TENS) and acupuncture are recognized as safe, non-invasive methods for sustained pain relief in DPN. More invasive procedures such as spinal cord stimulation (SCS) and radiofrequency ablation (RFA), while highly effective, are typically recommended only when non-invasive approaches fail. TENS and acupuncture are effective and economical approaches for DPN pain management. However, for cases where these methods do not provide sufficient relief, interventions such as SCS and RFA offer promising results in the hands of experienced clinicians. Treatment decisions should consider factors like cost, invasiveness, and the specific area affected by DPN.