A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET

Dawood Sayed; Timothy Ray Deer; Jonathan M Hagedorn; Asim Sayed; Ryan S D'Souza; Christopher M Lam; Nasir Khatri; Zohra Hussaini; Scott G Pritzlaff; Newaj Mohammad Abdullah; Vinicius Tieppo Francio; Steven Michael Falowski; Yussr M Ibrahim; Mark N Malinowski; Ryan R Budwany; Natalie Holmes Strand; Kamil M Sochacki; Anuj Shah; Tyler M Dunn; Morad Nasseri; David W Lee; Leonardo Kapural; Marshall David Bedder; Erika A Petersen; Kasra Amirdelfan; Michael E Schatman; Jay Samuel Grider

doi:10.2147/JPR.S451006

A Systematic Guideline by the ASPN Workgroup on the Evidence, Education, and Treatment Algorithm for Painful Diabetic Neuropathy: SWEET

J Pain Res. 2024 Apr 13:17:1461-1501. doi: 10.2147/JPR.S451006. eCollection 2024.

Authors

Dawood Sayed¹, Timothy Ray Deer², Jonathan M Hagedorn³, Asim Sayed⁴, Ryan S D'Souza³, Christopher M Lam¹, Nasir Khatri⁵, Zohra Hussaini¹, Scott G Pritzlaff⁶, Newaj Mohammad Abdullah⁷, Vinicius Tieppo Francio¹, Steven Michael Falowski⁸, Yussr M Ibrahim⁹, Mark N Malinowski¹⁰, Ryan R Budwany², Natalie Holmes Strand¹¹, Kamil M Sochacki¹², Anuj Shah¹³, Tyler M Dunn¹¹, Morad Nasseri¹⁴, David W Lee¹⁵, Leonardo Kapural¹⁶, Marshall David Bedder^{17

18}, Erika A Petersen¹⁹, Kasra Amirdelfan²⁰, Michael E Schatman^{21

22}, Jay Samuel Grider²³

Affiliations

¹ Department of Anesthesiology and Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA.
² Pain Services, Spine and Nerve Center of the Virginias, Charleston, WV, USA.
³ Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
⁴ Podiatry/Surgery, Susan B. Allen Memorial Hospital, El Dorado, KS, USA.
⁵ Interventional Pain Medicine, Novant Spine Specialists, Charlotte, NC, USA.
⁶ Department of Anesthesiology and Pain Medicine, University of California, Davis, Sacramento, CA, USA.
⁷ Department of Anesthesiology, University of Utah, Salt Lake City, UT, USA.
⁸ Neurosurgery, Neurosurgical Associates of Lancaster, Lancaster, PA, USA.
⁹ Pain Medicine, Northern Light Eastern Maine Medical Center, Bangor, ME, USA.
¹⁰ OhioHealth Neurological Physicians, OhioHealth, Columbus, OH, USA.
¹¹ Anesthesiology and Pain Medicine, Mayo Clinic, Phoenix, AZ, USA.
¹² Department of Anesthesiology and Perioperative Medicine, Rutgers Robert Wood Johnson, New Brunswick, NJ, USA.
¹³ Department of Physical Medicine and Rehabilitation, Detroit Medical Center, Detroit, MI, USA.
¹⁴ Interventional Pain Medicine / Neurology, Boomerang Healthcare, Walnut Creek, CA, USA.
¹⁵ Pain Management Specialist, Fullerton Orthopedic, Fullerton, CA, USA.
¹⁶ Carolinas Pain Institute, Winston Salem, NC, USA.
¹⁷ Chief of Pain Medicine Service, Augusta VAMC, Augusta, GA, USA.
¹⁸ Associate Professor and Director, Addiction Medicine Fellowship Program, Department Psychiatry and Health Behavior, Medical College of Georgia at Augusta University, Augusta, GA, USA.
¹⁹ Department of Neurosurgery, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
²⁰ Director of Clinical Research, Boomerang Healthcare, Walnut Creek, CA, USA.
²¹ Department of Anesthesiology, Perioperative Care & Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA.
²² Department of Population Health - Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA.
²³ Anesthesiology, Division of Pain Medicine, University of Kentucky College of Medicine, Lexington, KY, USA.

Abstract

Introduction: Painful diabetic neuropathy (PDN) is a leading cause of pain and disability globally with a lack of consensus on the appropriate treatment of those suffering from this condition. Recent advancements in both pharmacotherapy and interventional approaches have broadened the treatment options for PDN. There exists a need for a comprehensive guideline for the safe and effective treatment of patients suffering from PDN.

Objective: The SWEET Guideline was developed to provide clinicians with the most comprehensive guideline for the safe and appropriate treatment of patients suffering from PDN.

Methods: The American Society of Pain and Neuroscience (ASPN) identified an educational need for a comprehensive clinical guideline to provide evidence-based recommendations for PDN. A multidisciplinary group of international experts developed the SWEET guideline. The world literature in English was searched using Medline, EMBASE, Cochrane CENTRAL, BioMed Central, Web of Science, Google Scholar, PubMed, Current Contents Connect, Meeting Abstracts, and Scopus to identify and compile the evidence for diabetic neuropathy pain treatments (per section as listed in the manuscript) for the treatment of pain. Manuscripts from 2000-present were included in the search process.

Results: After a comprehensive review and analysis of the available evidence, the ASPN SWEET guideline was able to rate the literature and provide therapy grades for most available treatments for PDN utilizing the United States Preventive Services Task Force criteria.

Conclusion: The ASPN SWEET Guideline represents the most comprehensive review of the available treatments for PDN and their appropriate and safe utilization.

Keywords: chronic pain; diabetes; diabetic neuropathy; neuropathy; painful diabetic neuropathy; spinal cord stimulation.

Publication types

Review

Grants and funding

The SWEET guideline was supported by unrestricted educational grants from Abbott, Averitas, and Nevro.