The incidence of diabetes is expected to double over the next two decades, which will result in more people with complications of diabetes.1 Diabetic polyneuropathy is one of the most common, with a prevalence of around 30-50%. It can have a major impact on patients' quality of life, and treatment is usually needed for many years.2 3

Community based studies report the prevalence of painful diabetic polyneuropathy as around 16-26%,4 and in one study 80% of the patients had moderate or severe pain.5 Quality of life is reduced in patients with painful diabetic polyneuropathy, with restriction in daily and social activities, and the condition is associated with depression, sleep disturbances, and anxiety.3 6 7 In this week's BMJ Wong and colleagues report a systematic review of the effects of drug treatment in painful diabetic polyneuropathy.8

Many types of drugs have been studied for relief of pain in diabetic polyneuropathy,9 as little evidence exists that classic analgesics such as paracetamol or non-steroidal anti-inflammatory drugs are effective. Surveys show that there is substantial scope for improvement in clinical care. In one UK population based study almost 40% of people with painful neuropathy reported that they had never received …