Physical Activity in the Management of Diabetic Neuropathic Pain: A Narrative Review of Mechanisms, Evidence, and Clinical Perspectives.

Diabetic neuropathic pain (DNP) is a common and debilitating complication of diabetes mellitus, resulting from complex metabolic, vascular, and neuroinflammatory mechanisms. Pharmacological treatments provide limited relief, highlighting the need for adjunctive therapies. This review aimed to summarize current understanding of the pathophysiology of DNP and to evaluate the efficacy and mechanisms of physical activity (PA) in its management. A narrative synthesis of recent preclinical and clinical studies investigating the impact of exercise on DNP was conducted. Studies suggested that PA may improve insulin sensitivity, reduce oxidative stress, enhance microvascular blood flow, modulate neuroinflammation, and promote nerve regeneration. Clinical evidence demonstrates that aerobic, resistance, and multimodal exercise programs reduce pain severity, improve nerve conduction, and enhance functional outcomes. PA remains a safe and effective means in addition to pharmacological treatment in DNP. Tailored supervised exercise programs are recommended to optimize benefits. High-quality studies are still needed to establish standardized exercise protocols and long-term outcomes.