From animal model to diabetic complications. Is there a therapy for diabetic polyneuropathy based on the pathogenesis of pain?

Approximately 1/3 of all diabetic patients develop a peripheral neuropathy, which often leads to chronic pain. First-line pharmacological treatments according to current guidelines (gabapentin, pregabalin, tricyclic antidepressants) were found empirically and not prospectively according to their mode of action. For 20 years it has been a postulate to develop treatment approaches according to the pathophysiological mechanisms of painful diabetic polyneuropathy. The lack of progress in this field is at least partially due to a mismatch between animal models and patient phenotypes. Animal models focus on increased responsiveness to mechanical stimuli, which is present in less than 20% of patients. Patients report mainly ongoing pain accompanied by sensory loss to touch, cold and pinprick.