Neuropathic pain in diabetes mellitus: a systematic review of physiopathology, treatment and hypertension management
Year: 2026
Type: article
Study design: Systematic Review
Abstract: 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.
Authors: Nur Syifa Fauzia, Qianqian Xiao, Xiaopeng Mei
Language: English
Subfield: Physiology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7162680414
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