Neurotropic B vitamins in the management of pain syndrome in diabetic neuropathy: a review of current data | Ukrainian Medical Journal

Diabetic peripheral neuropathy (DPN) develops in 40–50% of patients with diabetes mellitus and is often accompanied by neuropathic pain, which reduces the quality of life and functional status. The pathogenesis of DPN is multifactorial and includes hyperglycemia, oxidative stress, microangiopathy, and demyelination. Analgesics do not provide a stable and long-lasting effect, since they do not affect the metabolic disorders of the nervous tissue. At the same time, neurotropic B vitamins (thiamine, pyridoxine, cyanocobalamin) are considered as a component of complex therapy that can help reduce neuropathic pain and support neuroreparative processes. Of particular importance is vitamin B₁₂ deficiency, in particular metformin-associated, which requires timely monitoring and correction. The article summarizes current data on the use of neurotropic B vitamins in painful DPN and presents a step-by-step approach to therapy taking into account the personalization of treatment.

References

1. Feldman E.L., Callaghan B.C., Pop-Busui R. et al. (2019) Diabetic neuropathy. Nature Reviews Disease Primers, 5(1): 42. doi.org/10.1038/s41572-019-0097-9.
2. American Diabetes Association Professional Practice Committee (2025) Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes — 2025. Diabetes Care, 48(Suppl. 1): S252–S265. doi.org/10.2337/dc25-S012.
3. Pop-Busui R., Boulton A.J., Feldman E.L. et al. (2017) Diabetic neuropathy: A position statement by the American Diabetes Association. Diabetes Care, 40(1): 136–154.
4. Price R., Smith D., Franklin G.M. et al. (2022) Painful diabetic polyneuropathy: AAN guideline update. doi.org/10.1212/WNL.0000000000013038.
5. Parsonage I., Wainwright D., Barratt J. (2025) Vitamin B12 deficiency in long-term metformin use and clinician awareness: A scoping review protocol. BMJ Open, 15(7): e101016. doi.org/10.1136/bmjopen-2025-101016.
6. Pinzon R.T., Schellack N., Matawaran B.J. et al. (2023) Clinical recommendations for the use of neurotropic B vitamins (B1, B6, and B12) for the management of peripheral neuropathy. J. Assoc. Phys. India, 71(7): 11–12. doi.org/10.59556/japi.71.0290.
7. Julian T., Syeed R., Glascow N. et al. (2020) B12 as a treatment for peripheral neuropathic pain: A systematic review. Nutrients, 12(8): 2221. doi.org/10.3390/nu12082221.
8. Didangelos T., Karlafti E., Kotzakioulafi E. et al. (2021) Vitamin B12 supplementation in diabetic neuropathy: A 1-year, randomized, double-blind, placebo-controlled trial. Nutrients, 13(2): 395. doi.org/10.3390/nu13020395.
9. Yang Y., Zhao B., Wang Y. et al. (2025) Diabetic neuropathy: Cutting-edge research and future directions. Signal Transduction and Targeted Therapy, 10(1): Article 132.
10. Karedath J., Batool S., Arshad A. et al. (2022) The impact of vitamin B12 supplementation on clinical outcomes in patients with diabetic neuropathy: A meta-analysis of randomized controlled trials. Cureus, 14(11): e31086. doi.org/10.7759/cureus.31086.
11. Eussen S.J.P.M., de Groot L.C.P.G.M., Clarke R. et al. (2005) Oral cyanocobalamin supplementation in older people with vitamin B12 deficiency: A dose-finding trial. Arch. Int. Med., 165(10): 1167–1172. doi.org/10.1001/archinte.165.10.1167.
12. Milgamma^® (Мільгама^®) інструкція (2026) Ліки Контроль. likicontrol.com.ua/%D1%96%D0%BD%D1%81%D1%82%D1%80%D1%83%D0%BA%D1%86%D1%96%D1%8F/?%5B27553%5D=.