BASBone and Arthrosurgery Science3083-48562981-8222Bio-Byword Scientific Publishing Pty. Ltd.10.26689/bas.v3i6.13316ArticleClinical Guideline for Perioperative Pain Management in Diabetic Foot Ulcershttps://artdesignp.com/journal/BAS/3/6/10.26689/bas.v3i6.13316ZongJunwei,FanShubo,GaoLei,ZhaoTianqi,ZhangZhen,WangShouyu2025362025-12-31This guideline outlines the pathophysiology and classification of neuropathic, ischemic, inflammatory, and procedural pain, and proposes a risk-stratified assessment using NRS/VAS combined with ulcer severity and comorbidities. Core recommendations emphasize preventive multimodal analgesia, prioritization of regional anesthesia, systematic management of neuropathic pain, protocolized procedural analgesia, and multidisciplinary collaboration.

Armstrong DG, Boulton AJM, Bus SA, 2017, Diabetic Foot Ulcers and Their Recurrence. The New England Journal of Medicine, 376(24): 2367–2375.

Blume PA, Walters J, Payne W, et al., 2008, Comparison of Negative Pressure Wound Therapy Using Vacuum-Assisted Closure with Advanced Moist Wound Therapy in the Treatment of Diabetic Foot Ulcers: A Multicenter Randomized Controlled Trial. Diabetes Care, 31(4): 631–636.

Bril V, England J, Franklin GM, et al., 2011, Evidence-Based Guideline: Treatment of Painful Diabetic Neuropathy. Neurology, 76(20): 1758–1765.

Bus SA, Armstrong DG, Gooday C, et al., 2020, Guidelines on Offloading Foot Ulcers in Persons with Diabetes (IWGDF 2019 Update). Diabetes/Metabolism Research and Reviews, 36(Suppl 1): e3274.

Chou R, Gordon DB, de Leon-Casasola OA, et al., 2016, Management of Postoperative Pain: A Clinical Practice Guideline from the American Pain Society, the American Society of Regional Anesthesia and Pain Medicine, and the American Society of Anesthesiologists’ Committee on Regional Anesthesia, Executive Committee, and Administrative Council. The Journal of Pain, 17(2): 131–157.

Dumville JC, Owens GL, Crosbie EJ, et al., 2013, Negative Pressure Wound Therapy for Treating Foot Ulcers in People with Diabetes Mellitus. Cochrane Database of Systematic Reviews, (10): CD010318.

Dworkin RH, O’Connor AB, Backonja M, et al., 2007, Pharmacologic Management of Neuropathic Pain: Evidence-Based Recommendations. Pain, 132(3): 237–251.

Finnerup NB, Attal N, Haroutounian S, et al., 2015, Pharmacotherapy for Neuropathic Pain in Adults: A Systematic Review and Meta-Analysis. The Lancet Neurology, 14(2): 162–173.

Game FL, Attinger C, Hartemann H, et al., 2016, IWGDF Guidance on Use of Interventions to Enhance the Healing of Chronic Ulcers of the Foot in Diabetes. Diabetes/Metabolism Research and Reviews, 32(Suppl 1): 75–83.

Noble M, Treadwell JR, Tregear SJ, et al. Long-Term Opioid Management for Chronic Noncancer Pain. Cochrane Database of Systematic Reviews. 2010(1): CD006605.

Pop-Busui R, Boulton AJM, Feldman EL, et al., 2017, Diabetic Neuropathy: A Position Statement by the American Diabetes Association. Diabetes Care, 40(1): 136–154.

Prompers L, Huijberts M, Apelqvist J, et al., 2007, High Prevalence of Ischaemia, Infection and Serious Comorbidity in Patients with Diabetic Foot Disease in Europe: Baseline Results from the Eurodiale Study. Diabetologia, 50(1): 18–25.

Treede R-D, Jensen TS, Campbell JN, et al., 2008, Neuropathic Pain: Redefinition and a Grading System for Clinical and Research Purposes. Neurology, 70(18): 1630–1635.

Tesfaye S, Boulton AJM, Dyck PJ, et al., 2010, Diabetic Neuropathies: Update on Definitions, Diagnostic Criteria, Estimation of Severity, and Treatments. Diabetes Care, 33(10): 2285–2293.

Schaper NC, Van Netten JJ, Apelqvist J, et al., 2020, Practical Guidelines on the Prevention and Management of Diabetic Foot Disease (IWGDF 2019 Update). Diabetes/Metabolism Research and Reviews, 36(Suppl 1): e3266.

Woo KY, Sibbald RG, Fogh K, et al., 2008, Assessment and Management of Persistent (Chronic) Wound Pain: A Consensus. International Wound Journal, 5(2): 159–177.

Zhang P, Lu J, Jing Y, et al., 2017, Global Epidemiology of Diabetic Foot Ulceration: A Systematic Review and Meta-Analysis. Annals of Medicine, 49(2): 106–116.

Lipsky BA, Senneville E, Abbas ZG, et al., 2020, Guidelines on the Diagnosis and Treatment of Foot Infection in Persons with Diabetes (IWGDF 2019 Update). Diabetes/Metabolism Research and Reviews, 36(Suppl 1): e3280.