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Painful neuropathy is present in 13% to 35% of diabetic patients, and the reasons for the differential clinical manifestations of painful and painless diabetic neuropathy (DNP) in diabetic patients are unclear. This review focuses on the latest clinical advances. It is observed that gender, diabetes type, glycosylated hemoglobin, and blood lipid levels have certain predictive effects on painful DNP. Clinical attention should be paid to pain and paresthesia caused by small fiber neuropathy. Existing diagnostic Methods have limited differential effect, and active drug treatment is required after the diagnosis of painful DNP is confirmed. Further research on the pathogenesis of painful DNP is required in order to find new therapeutic target.