More than 20 million people in the U.S. suffer from neuropathic pain, and at least 25% of these cases are classified as cryptogenic sensory polyneuropathy (CSPN), where the cause remains unknown.
Treating CSPN has been challenging for physicians due to a lack of clear guidelines on which medications are most effective.
Researchers from the University of Missouri aimed to address this gap by comparing four commonly used drugs in a large group of patients with CSPN. Their goal was to identify the most effective treatment options for this condition.
The study involved 402 patients aged 30 and older who had been diagnosed with CSPN and reported a pain score of four or greater on a 10-point scale.
Participants were randomly assigned to receive one of four medications: nortriptyline (a tricyclic antidepressant), duloxetine (a serotonin-norepinephrine reuptake inhibitor), pregabalin (an anti-seizure drug), or mexiletine (an anti-arrhythmic medication).
The treatment duration was 12 weeks, with evaluations at four, eight, and 12 weeks.
The findings showed that nortriptyline had the highest efficacy, with 25% of patients experiencing significant pain relief. It also had a relatively low dropout rate of 38%.
Duloxetine came in second, with a 23% efficacy rate and the lowest dropout rate of 37%. Pregabalin had the lowest efficacy rate at 15%, and mexiletine had the highest dropout rate at 58%.
Although none of the drugs emerged as a clear winner, nortriptyline and duloxetine stood out for their balance of effectiveness and patient retention.
Based on these results, the researchers recommend considering nortriptyline or duloxetine as first-line treatments for CSPN before trying other medications.
Beyond these four drugs, other nonnarcotic options are available for treating painful peripheral neuropathy, such as gabapentin, venlafaxine, and various sodium channel inhibitors.
The researchers suggest that additional comparative studies on these drugs could help build a more comprehensive understanding of the best treatments for CSPN.
The study, conducted by Richard Barohn and his team, was published in JAMA Neurology. This research highlights the importance of continued investigation into effective treatments for neuropathic pain, providing valuable insights for doctors and patients alike.
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