Pregabalin in the Management of Painful Diabetic Neuropathy: A Narrative Review

Shazli Azmi, Kariem T. ElHadd, Andrew Nelson, Adam Chapman, Frank L. Bowling, Anughara Perumbalath, Jonathan Lim, Andrew Marshall, Rayaz A. Malik, Uazman Alam

Research output: Contribution to journalReview articlepeer-review


Pregabalin is a first-line treatment in all major international guidelines on the management of painful diabetic neuropathy (pDPN). Treatment with pregabalin leads to a clinically meaningful improvement in pain scores, offers consistent relief of pain and has an acceptable tolerance level. Despite its efficacy in relieving neuropathic pain, more robust methods and comprehensive studies are required to evaluate its effects in relation to co-morbid anxiety and sleep interference in pDPN. The sustained benefits of modulating pain have prompted further exploration of other potential target sites and the development of alternative GABAergic agents such as mirogabalin. This review evaluates the role of pregabalin in the management of pDPN as well as its potential adverse effects, such as somnolence and dizziness, which can lead to withdrawal in ~ 30% of long-term use. Recent concern about misuse and an increase in deaths linked to its use has led to demands for reclassification of pregabalin as a class C controlled substance in the UK. We believe these demands need to be tempered in relation to the difficulties it would create for repeat prescriptions for the many millions of patients with pDPN for whom pregabalin provides benefit. Plain Language Summary: Plain language summary available for this article.

Original languageEnglish
Pages (from-to)35-56
Number of pages22
JournalDiabetes Therapy
Issue number1
Early online date18 Dec 2018
Publication statusPublished - 1 Feb 2019


  • Anxiety
  • GABAergic therapy
  • Neuropathic pain
  • Painful diabetic neuropathy
  • Pregabalin
  • Sleep interference


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