Neuropathic pain is a frequent condition caused by a lesion or disease of the central or peripheral somatosensory nervous system. A frequent cause of peripheral neuropathic pain is diabetic neuropathy. Its complex pathophysiology is not yet fully elucidated, which contributes to underassessment and undertreatment. A mechanism-based treatment of painful diabetic neuropathy is challenging but phenotype-based stratification might be a way to develop individualized therapeutic concepts. Our goal is to review current knowledge of the pathophysiology of peripheral neuropathic pain, particularly painful diabetic neuropathy. We discuss state-of-the-art clinical assessment, validity of diagnostic and screening tools, and recommendations for the management of diabetic neuropathic pain including approaches towards personalized pain management. We also propose a research agenda for translational research including patient stratification for clinical trials and improved preclinical models in relation to current knowledge of underlying mechanisms.

中文翻译：

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神经性疼痛的挑战：专注于糖尿病性神经病变。

神经性疼痛是由中枢或外周体感神经系统的病变或疾病引起的常见病症。周围神经性疼痛的常见原因是糖尿病性神经病。其复杂的病理生理学尚未完全阐明，这导致评估不足和治疗不足。基于机制的疼痛性糖尿病神经病变的治疗具有挑战性，但基于表型的分层可能是发展个性化治疗概念的一种方式。我们的目标是回顾有关周围神经性疼痛（尤其是疼痛性糖尿病性神经病变）的病理生理学的最新知识。我们讨论了最新的临床评估，诊断和筛查工具的有效性以及有关糖尿病性神经性疼痛管理的建议，包括针对个性化疼痛管理的方法。