Diabetic peripheral neuropathy is one of the most common complications of diabetes, ranging from devastating to asymptomatic status. The symptoms manifested by patients are various and the courses are not sequential, which makes the diagnosis not simple. Although the symptoms cannot be dichotomized, the symptoms are categorized as positive and negative. Depending on the affected legion of the nervous system, symptoms can be different. Pain is a typical positive symptom alleviating the quality of life of patients with diabetic peripheral neuropathy. Previous studies have shown that clinical manifestations of painful and painless diabetic neuropathy are not exclusive. Several hypothetical theories of neuropathic pain generation are suggested while pathogenetic mechanisms of painful diabetic peripheral neuropathy are still elusive. It is crucial to understand the characteristics of painful and painless diabetic neuropathy when we treat patients. At this talk, the difference between painful and painless diabetic neuropathy will be addressed in clinical, epidemiological, and pathogenetic aspects.