Therapeutic target
- Improvement of the general quality of life
Therapy recommendations
- Treat the cause (e.g. diabetes mellitus; alcohol abuse; vitamin deficiency) as far as treatable!
- Positive symptoms such as tingling, burning, and pain are treated symptomatically with medication; this applies in particular to the therapy of painful polyneuropathy (= neuropathic pain); it should always be supported by non-drug measures. Notice: Neuropathic pain occurs in approximately 50% of cases of polyneuropathy.
- Therapy for painful polyneuropathy should begin as early as possible and thus lead to an improvement in overall quality of life.
- Analgesia according to WHO staging scheme:
- Non-opioid analgesic (paracetamol, first-line agent).
- Low-potency opioid analgesic* (e.g., tramadol) + non-opioid analgesic (use short-term for severe pain).
- High-potency opioid analgesic* (e.g., morphine) + non-opioid analgesic.
Neuropathic pain – opioid analgesics, anticonvulsants, antidepressants.
- Agents for first-line therapy: antiepileptic drugs such as gabapentin and pregabalin, serotonin–norepinephrine reuptake inhibitors such as duloxetine and venlafaxine, and tricyclic antidepressants.
Notice: Negative symptoms such as numbness (hypesthesia) and balance disorders are very difficult to influence.
Further notes on therapy
- See the chapter “Therapy of Polyneuropathies in the Therapy Manual” and DGN (German Society of Neurology) guideline, “Therapy of Acute and Chronic Immune-Mediated Neuropathies and Neuritides” [S2e guideline].
