Neuropathic pain in diabetes mellitus: a systematic review of physiopathology, treatment and hypertension management

Diabetic neuropathic pain (DNP) is a debilitating complication of diabetes mellitus, arising from a complex interplay of metabolic, vascular, and neuroinflammatory mechanisms. This systematic review synthesizes current evidence on the pathophysiology and treatment of DNP, with a specific focus on its intersection with cardiovascular comorbidity, particularly hypertension. The analysis reveals that the pathogenesis of DNP shares critical pathways with hypertension, including endothelial dysfunction, chronic low-grade inflammation, oxidative stress, and sympathetic dysregulation. This shared biology suggests a synergistic relationship where each condition potentiates the other, complicating clinical management. While pharmacological therapies such as gabapentinoids and serotonin-norepinephrine reuptake inhibitors (SNRIs) form the mainstay of symptomatic treatment, their efficacy is often limited, and their side-effect profiles necessitate careful consideration in patients with concomitant hypertension. The review advocates for a paradigm shift towards integrated, phenotype-informed management. This approach combines personalized analgesic strategies with aggressive, multifactorial cardiovascular risk reduction, including stringent blood pressure control, lifestyle modification, and targeted supplementation. A holistic care model that concurrently addresses neuropathic pain and systemic vascular health is essential for improving long-term outcomes and quality of life in this high-risk patient population.