Neuropathic pain affects over 20 million people in the United States, and a significant portion of these cases, around 25%, are classified as cryptogenic sensory polyneuropathy (CSPN), with no clear explanation for the pain.
Unfortunately, there is a lack of information guiding physicians in selecting appropriate drugs to treat CSPN.
However, researchers from the University of Missouri have recently conducted a study comparing four commonly used drugs to determine their effectiveness in managing this condition and have identified the most useful treatment.
Comparing Four Drugs for CSPN
The study included 402 patients, aged 30 years and older, who had been diagnosed with CSPN and reported a pain score of four or higher on a 10-point scale.
These participants were prescribed one of four medications commonly used to treat CSPN: nortriptyline (a tricyclic antidepressant), duloxetine (a serotonin-norepinephrine reuptake inhibitor), pregabalin (an anti-seizure drug), or mexiletine (an anti-arrhythmic medication).
The patients took the prescribed treatment for 12 weeks and were evaluated at four, eight, and 12 weeks.
Identifying the Most Effective Drug: The researchers found that nortriptyline had the highest percentage of efficacy (25%) and the second-lowest dropout rate (38%), making it the drug with the highest overall utility.
Duloxetine had the second-highest efficacy rate (23%) and the lowest dropout rate (37%). Pregabalin had the lowest efficacy rate (15%), while Mexiletene had the highest dropout rate (58%).
The study did not identify a clearly superior drug, but considering both efficacy and dropout rates, nortriptyline and duloxetine performed better overall.
Recommendations for Treatment
Based on the findings, the researchers recommend considering either nortriptyline or duloxetine as the initial options for treating CSPN before exploring other medications.
They acknowledge that there are additional nonnarcotic drugs used for painful peripheral neuropathy, such as gabapentin, venlafaxine, and other sodium channel inhibitors.
Conducting further comparative effectiveness research on these drugs will help doctors expand their knowledge and establish a comprehensive library of data for treating CSPN.
Conclusion
The study conducted by Richard Barohn et al., published in JAMA Neurology, provides valuable insights into finding effective treatments for cryptogenic sensory polyneuropathy (CSPN).
While there is currently no single superior drug for CSPN, nortriptyline and duloxetine demonstrated better efficacy and lower dropout rates in the study.
Physicians are encouraged to consider these options before exploring other medications.
Furthermore, future research should focus on conducting comparative effectiveness studies on additional nonnarcotic drugs to expand the available treatment options for CSPN.
By advancing our understanding of CSPN and its management, we can improve the lives of millions of individuals affected by this condition.
If you care about pain, please read studies about yogurt linked to lower frailty in older people, and tart cherry could help reduce inflammation.
For more information about health, please see recent studies that the painkiller ibuprofen may strongly influence your liver, and results showing Marijuana for pain relief may lead to withdrawal symptoms.
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