After carefully reading the article written by Baozhong Yang et al1 titled Diabetic Neuropathic Pain and Circadian Rhythm: A Future Direction Worthy of Study has several advantages about focusing on the relationship between diabetic neuropathic pain and circadian Rhythm, the importance of Clinical Research, a multidisciplinary approach, the potential for new therapies, and new innovations in treatment.

In addition to these advantages, there are some disadvantages of this study, namely the lack of in-depth clinical research where there are several studies showing the link between diabetic neuropathic pain and circadian rhythm, more in-depth and detailed clinical research is still needed to confirm these findings and understand the underlying mechanisms. This is in line with Rebecca Mercieca-Bebber2 where clinical research provides evidence-based strategies to promote high-quality PRO data collection, analysis, and reporting of PRO evidence. Another thing is that research shows that less than 50% of patients who receive current treatment feel better, suggesting that there is significant variability in response to existing therapies. This indicates the need for a more personalized approach to treatment. The study noted gender differences in pain experience, most of the research was done on male animal models, with little attention paid to female animals. This can lead to bias in understanding how neuropathic pain affects men and women differently. Furthermore, there is potential for using chronotherapy in the treatment of neuropathic pain, existing research is still limited and more evidence is needed to support its effectiveness in clinical practice. The scant evidence will result in bias for an interventional study. This is in line with the article Agussalim et al3 in Pannucci said that bias can be avoided with Known confounders controlling with study design or during data analysis. Unknown confounders can only be controlled with randomization.

Further research improvements related to Diabetic Neuropathic Pain and Circadian Rhythm in accordance with all inputs will help in improving the perfection of future research.

The authors report no conflicts of interest in this communication.

1. Yang B, Wei W, Fang J, et al. Diabetic Neuropathic Pain and Circadian Rhythm: A Future Direction Worthy of Study. J Pain Res. 2024;17:3005–3020. doi:10.2147/JPR.S467249

2. Mercieca-Bebber R, King MT, Calvert MJ, et al. The importance of patient-reported outcomes in clinical trials and strategies for future optimization. Patient Related Outc Measu. 2018;9:353–367. doi:10.2147/PROM.S156279

3. Agussalim, Pujiastuti RS, Nugroho HS, et al. Respond to the Effectiveness of Electroacupuncture for Diabetic Peripheral Neuropathy and Exploring the Feasibility of Infrared Thermography [Letter]. J Pain Res. 2024;Volume 17:2949–2950. doi:10.2147/PROM.S156279