***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: A prospect i ve survey study was performed in patients with painful diabetic polyneuropathy ( PDN ) to assess the nature and scope of their pain . Pain associated with diabetic neuropathy is commonly encountered in clinical practice . Yet , little is known regarding the pain experience and impact on quality of life in persons with painful diabetic neuropathy . These 105 patients noted an average of 6/10 pain , most often described as ' burning ' , ' electric ' , ' sharp ' , and ' dull/ache ' , which , for most , is worse at night time and when tired or stressed . On average , patients reported that the pain caused substantial interference in sleep and enjoyment of life and moderate interference in recreational activities , normal work , mobility , general activity , social activities , and mood . Unexpectedly , a potential genetic predisposition to the development of painful neuropathy was suggested by the fact that a majority ( 56 % ) reported a family member with PDN . Thus , this study found that pain associated with diabetic neuropathy is a significant medical issue that has a substantial impact on the quality of life of many people with this condition & NA ; Levodopa has been used to treat some painful conditions and found to be effective in neuropathic pain due to herpes zoster in a double‐blind study . From our anecdotal observations about the efficacy of levodopa on diabetic neuropathic pain , we design ed a double‐blind placebo‐controlled study to test levodopa in painful diabetic neuropathy . Twenty‐five out‐ patients with painful symmetrical diabetic polyneuropathy were admitted to the study . Fourteen patients were given 100 mg levodopa plus 25 mg benserazide to be taken three times per day for 28 days . Eleven patients were given identical placebo capsules . A blinded neurologist evaluated the patients clinical ly and performed Visual Analogue Scale ( VAS ) measurement every week from day 0 to day 28 . The results seemed promising and levodopa may be a choice for the control of pain in neuropathy for which we do not have many alternative treatments BACKGROUND Both basic and clinical research has demonstrated that antiepileptic drugs can be effective in alleviating neuropathic pain . It was hypothesized that oxcarbazepine might be effective in reducing the symptoms of painful diabetic neuropathy . AIMS To investigate the long-term efficacy and safety of oxcarbazepine in symptoms of painful diabetic neuropathy . MATERIAL S AND METHODS This study included thirty-eight painful diabetic neuropathy patients , which were screened with clinical assessment and electrophysiological studies . The efficacy and safety of oxcarbazepine were evaluated according to the changes in pain intensity and social interference subitems scores of Short-form Brief Pain Inventory besides electrophysiological studies at the end of six months of the treatment . STATISTICAL ANALYSIS The Students t , Mann-Whitney U and Rank Sum test and Chi-square tests were applied to examine variables differences . The level of statistical significance was chosen to be P<0.05 . RESULTS A significant difference was found in all of subitems of pain intensity and social interference at the end of the study according to the baseline scores . Improvement was observed in 52.7 % , 63.1 % , 55.3 % and 63.2 % of patients for worst , least , average and pain right now at the end of six months , respectively . Improvement was observed as 60.6 % , 63.2 % , 52.6 % , 60.5 % , 68.4 % and 63.2 % for general activity , mood , walk , work , people relations , sleep and life enjoyment subitems , respectively . None of these patients had any prominent side effect leading to discontinue the treatment . CONCLUSION Long-term oxcarbazepine treatment was found to be effective and safe in the symptoms of painful diabetic neuropathy AIMS To determine the prevalence and risk factors for neuropathy and peripheral vascular disease ( PVD ) in the Australian diabetic population and identify those at high risk of foot ulceration . METHODS The Australian Diabetes Obesity and Lifestyle study included 11 247 adults aged > or= 25 years in 42 r and omly selected areas of Australia .  Neuropathy and PVD were assessed in participants identified as having diabetes ( based on self report and oral glucose tolerance test ) , impaired fasting glucose , impaired glucose tolerance and in a r and om sample with normal glucose tolerance ( total n = 2436 ) . RESULTS The prevalence of peripheral neuropathy was 13.1 % in those with known diabetes ( KDM ) and 7.1 % in those with newly diagnosed ( NDM ) . The prevalence of PVD was 13.9 % in KDM and 6.9 % in NDM . Of those with diabetes , 19.6 % were at risk of foot ulceration . Independent risk factors for peripheral neuropathy were diabetes duration ( odds ratio ( 95 % CI ) 1.73 ( 1.33 - 2.28 ) per 10 years ) , height ( 1.42 ( 1.08 - 1.88 ) per 10 cm ) , age ( 2.57 ( 1.94 - 3.40 ) per 10 years ) and uric acid ( 1.59 ( 1.21 - 2.09 ) per 0.1 mmol/l ) . Risk factors for PVD were diabetes duration ( 1.64 ( 1.25 - 2.16 ) per 10 years ) , age ( 2.45 ( 1.86 - 3.22 ) per 10 years ) , smoking ( 2.07 ( 1.00 - 4.28 ) ) , uric acid ( 1.03 ( 1.00 - 1.06 ) per 0.1 mmol/l ) and urinary albumin/creatinine ratio ( 1.11 ( 1.01 - 1.21 ) per 1 mg/mmol ) . CONCLUSIONS The prevalence of neuropathy and PVD was lower in this population than has been reported in other population s. This may reflect differences in sampling methods between community and hospital-based population s. Nevertheless , a substantial proportion of the diabetic population had risk factors for foot ulceration BACKGROUND A cause- and -effect relation between blood glucose concentrations and microvascular complications in patients with insulin-dependent diabetes mellitus has not been established . METHODS We r and omly assigned 102 patients with insulin-dependent diabetes mellitus , nonproliferative retinopathy , normal serum creatinine concentrations , and unsatisfactory blood glucose control to intensified insulin treatment ( 48 patients ) or st and ard insulin treatment ( 54 patients ) . We then evaluated them for microvascular complications after 18 months and 3 , 5 , and 7.5 years . RESULTS Mean ( + /- SD ) glycosylated hemoglobin values were reduced from 9.5 + /- 1.3 percent to 7.1 + /- 0.7 percent in the group receiving intensified treatment and from 9.4 + /- 1.4 percent to 8.5 + /- 0.7 percent in the group receiving st and ard treatment ( P = 0.001 ) . In 12 of the patients receiving intensified treatment ( 27 percent of those included in the analysis ) and 27 of those receiving st and ard treatment ( 52 percent ) , serious retinopathy requiring photocoagulation developed ( P = 0.01 ) . Visual acuity decreased in 6 patients receiving intensified treatment ( 14 percent ) and in 18 receiving st and ard treatment ( 35 percent ) ( P = 0.02 ) . Nephropathy ( urinary albumin excretion , > 200 micrograms per minute ) developed in one patient in the group receiving intensified treatment , as compared with nine patients in the group receiving st and ard treatment ( P = 0.01 ) . No patient in the intensified-treatment group had nephropathy with subnormal glomerular filtration rates , as compared with six patients in the st and ard-treatment group ( P = 0.02 ) . The conduction velocities of the ulnar , tibial , peroneal , and sural nerves decreased significantly more in the st and ard-treatment group than in the intensified-treatment group . The odds ratio for serious retinopathy was 0.4 ( 95 percent confidence interval , 0.2 to 1.0 ; P = 0.04 ) in the intensified-treatment group as compared with the st and ard-treatment group . The corresponding odds ratio for nephropathy was 0.1 ( 95 percent confidence interval , 0 to 0.8 ; P = 0.04 ) . CONCLUSIONS Long-term intensified insulin treatment , as compared with st and ard treatment , retards the development of microvascular complications in patients with insulin-dependent diabetes mellitus AIMS /HYPOTHESIS To study similarities and differences between people with insensate or painful diabetic peripheral neuropathy , particularly in relation to height , gender , ethnicity and glycaemic control . METHODS We studied prospect ively 2610 patients with Type 2 diabetes attending our Diabetes Centre . Subjects were compared according to degree of sensory loss , and presence or absence of neuropathic pain . The effects of gender and ethnicity were evaluated by study ing patients in different height b and s. RESULTS Insensate neuropathy and painful neuropathy was present in 11.4 and 3.3 % of subjects , respectively . Age , duration of diabetes , height , vibration perception and HbA(1c ) ( P<0.0001 ) were independent determinants of insensate neuropathy , whereas only duration of diabetes and vibration perception ( P<0.0001 ) were predictive of pain . There was more insensate neuropathy in males ( OR 1.9 ) and anglo-celtics ( OR 1.4 ) but stratification by height showed that these effects were due to height . Height has no influence on the development of pain . CONCLUSIONS There is significant overlap but also considerable dichotomy in the two major forms of diabetic sensory peripheral neuropathy . The insensate type is more explainable by duration , degree of hyperglycaemia and length of peripheral nerves , factors that are likely to reflect severity of underlying structural nerve damage . Glycaemic control was not a predictor of painful neuropathy & NA ; Pregabalin binds with high affinity to the alpha2‐delta subunit protein of voltage‐gated calcium channels and , thereby , reduces release of excitatory neurotransmitters . This 12‐week r and omised , double‐blind , multicentre , placebo‐controlled , parallel‐group study evaluated the efficacy and safety of pregabalin in patients with chronic postherpetic neuralgia ( PHN ) or painful diabetic peripheral neuropathy ( DPN ) . Patients were r and omised to  placebo ( n=65 ) or to one of two pregabalin regimens : a flexible schedule of 150 , 300 , 450 , and 600 mg/day with weekly dose escalation based on patients ' individual responses and tolerability ( n=141 ) or a fixed schedule of 300 mg/day for 1 week followed by 600 mg/day for 11 weeks ( n=132 ) . Both flexible‐ and fixed‐dose pregabalin significantly reduced endpoint mean pain score ( primary outcome ) versus placebo ( P=0.002 , P<0.001 ) and were significantly superior to placebo in improving pain‐related sleep interference ( P<0.001 ) . The most common adverse events ( AEs ) for pregabalin‐treated patients were dizziness , peripheral oedema , weight gain ( not affecting diabetes control ) , and somnolence . These results are consistent with previous studies ' demonstrating pregabalin 's efficacy , tolerability , and safety for treatment of chronic neuropathic pain associated with DPN or PHN . Pregabalin dosing aim ed at optimal balance of efficacy and tolerability provides significant pain relief and may reduce risks for AEs and therapy discontinuation OBJECTIVE To prove the efficacy of mexiletine in painful diabetic neuropathy . RESEARCH DESIGN AND METHODS Treatment was provided in three dosages . For pain measurements , a VAS and McGill 's verbal rating scale were chosen . Ninety-five patients were included in the study . RESULTS A global assessment of the VAS among patients showed no differences between mexiletine treatment and placebo . The total evaluation ( PRIT ) of the McGill scale fell just below the level of significance . More specific exploratory evaluations of subclasses of the McGill scale , representing different degrees of pain , gave remarkable differences between mexiletine and placebo in sensory and miscellaneous items . In special subgroups , which were formed according to types and courses of complaints compiled at the beginning of this evaluation , the substantial advantages of the mexiletine treatment were shown with both the VAS and the McGill scale . CONCLUSIONS Evidence strongly indicates that , in particular , those patients with stabbing or burning pain , heat sensations , or formication will benefit most by mexiletine therapy . Concerning the dosage , a medium regimen of 450 mg/day seems to be appropriate . With an increase in the antiarryhthmic dosage level , the efficacy does not rise proportionally . Mexiletine proved to be a safe therapy with negligible side effects at the medium dose range , even < placebo ; and remarkably , no cardiovascular side effects were noted . Further studies should avoid global assessment s and pay more attention to the variety of complaints and quality of life 
    Output:
    
Anticonvulsants and antidepressants are still the most commonly used options to manage diabetic neuropathy .
Oral tricyclic antidepressants and traditional anticonvulsants are better for short term pain relief than newer generation anticonvulsants .
Evidence of the long term effects of oral antidepressants and anticonvulsants is still lacking .