Clinicians have many options in choosing a drug therapy for diabetic neuropathy. Antidepressants, anticonvulsants and opioids are the main drugs used to treat neuropathic pain. Which medication, or more likely, combination of medications, is right for you may seem like a game of trial and error.
A recent meta-analysis (Drug Treatments for Diabetic Neuropathy: A Meta-Analysis. Allan S. Brett, MD Reviewing Griebeler ML et al., Ann Intern Med 2014 Nov 4; 161:639) of drug therapies for painful diabetic neuropathy looked at 65 relevant randomized trials involving 27 medications, with nearly 13,000 participants. The study revealed:
- Serotonin-norepinephrine reuptake inhibitors (SNRIs), topical capsaicin, tricyclic antidepressants (TCAs), and anticonvulsants all reduced pain compared with placebo.
- As a group, SNRIs and TCAs reduced pain more than did anticonvulsants and capsaicin.
- For individual drugs, carbamazepine, venlafaxine, duloxetine, amitriptyline, and pregabalin1 were statistically superior to placebo.
- Few head-to-head comparisons of individual drugs exist, and most showed insignificant differences between drugs; however, pregabalin was inferior to venlafaxine and duloxetine.
- Side-effect profiles differ among these drug classes; adverse effects were problematic with virtually all of them.
This analysis also pointed out that most studies were short-term, and most of these drugs have substantial central nervous system side effects. Moreover, comparative results are somewhat skewed by the size of randomized trials: For example, although the mean reduction in pain was slightly more with gabapentin than with pregabalin, only pregabalin’s results were statistically significant, because its industry-sponsored trials were much larger than those of gabapentin. Currently, only duloxetine and pregabalin are FDA-approved for treating patients with diabetic neuropathy.
At US Neuropathy Centers, we will work to tailor a treatment program to your specific needs. From a better way to tailor traditional medication management, to alternative pain relief strategies, such as electric stimulation, medical foods, infusion therapies and more, to topical medications that might result in less side effects, and even surgical options, our physicians look at you as an individual, not a diagnosis. Call one of your centers today to book your appointment!
Find one of our locations at www.usneuropathycenters.com.
The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
@US Neuropathy Centers, 2018