• Der Internist · Mar 2020

    Review

    [Treatment of polyneuropathy: autonomic symptoms and pain].

    • J Sachau, S-C Fabig, S Rehm, and R Baron.
    • Sektion Neurologische Schmerzforschung und -therapie, Klinik für Neurologie, Universitätsklinikum Schleswig-Holstein, Campus Kiel, Kiel, Deutschland.
    • Internist (Berl). 2020 Mar 1; 61 (3): 270-276.

    BackgroundThe treatment of polyneuropathy includes symptomatic therapy of sensory, motor and autonomic dysfunctions.AimThis article provides an overview of the current treatment recommendations for polyneuropathy, focusing on pain.MethodsCurrent treatment guidelines will be discussed based on a literature research.ResultsCalcium-channel anticonvulsants gabapentin/pregabalin as well as antidepressants duloxetine and amitriptyline are recommended as first line therapeutics. Alternatively, topical therapeutics can be used in the case of localized disorders. In individual cases, opioids or other antidepressants/anticonvulsants may be effective. Pharmacological treatment is often limited due to adverse events, which affect the central nervous system in particular.DiscussionIn general, treatment for polyneuropathy should follow a multimodal concept and include the treatment of other symptoms. When choosing pain medication, comorbidities, patient's age and adverse events need to be taken into consideration. Phenotype-based stratification may support specialized pain therapy and achieve the best medical treatment.

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