Abstract :Abstract
Treatment of Painful Diabetic Neuropathy (PDN) is still quite suboptimal. The use of many of the
analgesics and co-analgesics recommended in most guidelines is complicated by issues as adverse
events, low compliance and drug-drug interactions. Thus, the numbers needed to treat for most
drugs in this field is relative high, while numbers needed to harm are low. This holds true for the
western industrialized population, but definitely also for populations in Sub-Saharan Africa (SSA),
as most of the analgesics of choice are not listed on the essential lists of these countries. Detailed
data on the prevalence and incidence of PDN are also missing. It is estimated that PDN will increase
considerably in the near future. Moreover, well controlled clinical trials evaluating the efficacy and
safety of most currently used analgesics in these countries are extremely scarce if not absent. As the
metabolism in the black population is known to be different from the white population, side-effects
can vary and toxic metabolites might be induced in both populations in different frequencies, as has
been demonstrated for opioids. Thus, there is a great need for new approaches in the treatment of
PDN, and repositioning old drugs in new topical formulations might be of use. We will present the
rationale to evaluate topical Phenytoin cream as a new treatment option in PDN, suitable for the
SSA and present first steps related to a pilot trial in the Gambia.