Although considerable improvement in the quality of controlled trials has recently been achieved, no major breakthrough in slowing the progression of diabetic neuropathy in the long run has been achieved with drugs used on the basis of present pathogenetic concepts. Some of the newer drugs have shown promising results in phase II trials which require confirmation from large phase III trials. It is conceivable that drugs interfering with the pathogenesis of diabetic neuropathy may be most effective in terms of prevention, rather than intervention. Although several novel analgesic drugs have recently been introduced into clinical practice, the pharmacologic treatment of chronic painful diabetic neuropathy remains a challenge for the physician. Individual tolerability remains a major aspect in any treatment decision. Almost no information is available from controlled trials on long-term analgesic efficacy and only a few studies have used drug combinations. Combination drug use or the addition of a new drug to a therapeutic regimen may lead to increased efficacy. In future, drug combinations may also include those aimed at symptomatic pain relief and quality of life on the one hand, and improvement or slowing of the progression of the underlying neuropathic process on the other hand.
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