Diabetic painful neuropathy is a difficult clinical problem for which there is no ideal treatment. The ideal treatment should combine significant improvement or elimination of the subjective symptoms of pain with improvement of objective functional (e.g. electrophysiological) or structural (nerve biopsy) indices of neuropathy. To achieve this, the mechanism of diabetic painful neuropathy must first be understood. Pain neuropathy is a sensory neuropathy, but interestingly, most patients with diabetic peripheral neuropathy do not feel pain, but rather have abnormal sensation, hypoesthesia or absence of sensation, and only some of them complain of pain. Therefore, the mechanism of painful neuropathy remains unclear. Although it is a peripheral neuropathy, experiments have shown that there are changes at the cellular level and gene expression level at all levels of the nerve axis, such as the brain, spinal cord, peripheral nerves, and autonomic nerves, and that there is atrophy of nerve axons, demyelination, loss of nerve fibers, and repair and regeneration of diseased nerve fibers. The diagnosis of diabetic painful neuropathy is generally not difficult based on the history and neurological examination. The disease is a sensory peripheral neuropathy with a distal symmetrical sock-like or glove-like distribution, starting with the toes, feet and calves of the lower extremities, and may involve the distal upper extremities if it travels up to the knees. Occasionally, only the hands are involved, which should be distinguished from carpal tunnel syndrome. Patients with diabetic painful neuropathy complain of mainly pain. It is important to understand the nature and characteristics of the pain and its impact on quality of life such as sleep, activity, and mood. Patients describe the nature of pain in a variety of ways, but burning, hot, cutting, insect biting, tearing, and pins and needles pain are more common, especially at night. The degree and duration of pain varies from person to person, ranging from mild to severe, recurrent short bouts or transient to constant pain. In addition to pain, there may be other sensory abnormalities, such as numbness, ankylosis, itching or sensory hypersensitivity, hyperalgesia or absence, the latter of which is particularly serious because of the risk of foot injury, infection, ulceration and amputation. Diabetic nociceptive neuropathy is often associated with abnormal nociceptive hypersensitivity, for example, touch and cold or hot stimuli that normally do not cause pain can induce significant pain sensation at this time. Diabetic painful neuropathy belongs to the category of metabolic peripheral neuropathy, like diabetic retinopathy and diabetic nephropathy, in which poor glycemic control is the main cause. Studies have shown that diabetic neuropathy is more closely related to glycemic control than other diabetic complications. This is because the uptake of glucose by nerve cells is not insulin-mediated, but rather glucose enters the nerve cells directly. The incidence of diabetic neuropathy increases with elevated glycosylated hemoglobin, from a few times the normal prevalence at that time to a multiple. Therefore, good glycemic control is the basis for the treatment of diabetic painful neuropathy. In addition, patient education and foot care are also important. Pharmacological treatment of pain can be divided into two categories: one is drugs that target the pathogenesis of neuropathy or pain mechanism; the other is symptomatic treatment (analgesia). The new generation of aldose reductase inhibitors such as Fidelis, recent clinical trials have reported that this product has the effect of promoting nerve regeneration, and has a significant effect on reducing pain and improving electrophysiological indicators. Sodium channel antagonists such as lidocaine and slow heart rhythm, local anesthetics and antiarrhythmic drugs, because of its sodium channel antagonism, can reduce the abnormal discharge of injured nerves. Tricyclic antidepressants are also effective. Anticonvulsants phenytoin and carbamazepine are commonly used, but the efficacy is poor. Opiates can be used in patients who have not been treated with other drugs, such as methadone or long-acting hydroxycodone, which can relieve pain and improve the quality of life, but attention should be paid to addiction. Topical medications such as analgesic spray, lidocaine gel or patch, and chlorpheniramine cream or patch are an innovation in the treatment of painful neuropathy in recent years, because they have the advantages of acting directly on the affected area, no systemic side effects, no drug interactions and no need to adjust the dose, they are expected to become the first-line drugs in the treatment of diabetic painful neuropathy in the future and occupy an important position in the treatment of this disease. In recent years, the use of spinal cord electrical stimulation has been reported internationally for the treatment of this disease, and according to the literature, the efficacy is also very good, improving local limb blood flow and significantly relieving the pain of patients.