Neuropathic pain affects more than 20 million people in the U.S., and for many of them, the cause of their pain remains a mystery.
A significant portion of these cases—at least 25%—fall under a condition known as cryptogenic sensory polyneuropathy (CSPN), where the exact cause of the pain cannot be identified.
Unfortunately, there has been little information available to guide doctors in choosing the most effective medication to treat this condition.
A recent study from the University of Missouri aimed to address this gap by comparing four commonly used drugs to see which one works best for patients with CSPN.
The study involved 402 participants, all of whom were 30 years or older and had been diagnosed with CSPN. These patients also reported experiencing significant pain, with scores of four or higher on a 10-point scale.
The participants were randomly assigned to take one of four medications: nortriptyline, a tricyclic antidepressant; duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI); pregabalin, an anti-seizure medication; or mexiletine, an anti-arrhythmic drug.
The patients followed their prescribed treatment for 12 weeks, with their progress evaluated at four, eight, and 12 weeks.
The results of the study provided some valuable insights. Nortriptyline emerged as the most effective of the four medications, with 25% of the patients experiencing significant relief from their pain.
It also had the second-lowest drop-out rate, with 38% of participants discontinuing the medication during the study. This combination of effectiveness and relatively low quit rate gave nortriptyline the highest overall utility score among the drugs tested.
Duloxetine was not far behind, showing a 23% efficacy rate and the lowest drop-out rate at 37%. This suggests that duloxetine is also a strong option for treating CSPN, particularly for patients who may be concerned about the side effects leading them to stop the treatment.
Pregabalin, on the other hand, had the lowest efficacy rate at just 15%, while mexiletine had the highest quit rate, with 58% of participants stopping the medication before the study ended.
These findings suggest that pregabalin and mexiletine may be less effective or less tolerable for patients with CSPN compared to nortriptyline and duloxetine.
Despite these findings, the researchers noted that there was no single drug that stood out as clearly superior in all aspects. However, given their performance in the study, nortriptyline and duloxetine are recommended as the first options for doctors to consider when treating CSPN.
The study also highlighted the need for further research. There are other nonnarcotic medications commonly used to treat neuropathic pain, such as gabapentin, venlafaxine, and various sodium channel inhibitors.
The researchers suggested that additional studies comparing these drugs could help build a more comprehensive understanding of the best treatments for CSPN.
This study, published in JAMA Neurology and led by Richard Barohn and his team, provides important guidance for healthcare providers.
While treating CSPN can be challenging due to the unexplained nature of the pain, having data-driven recommendations can help doctors make better-informed decisions, potentially improving outcomes for patients who suffer from this difficult condition.
If you care about pain, please read studies about vitamin K deficiency linked to hip fractures in old people, and these vitamins could help reduce bone fracture risk.
For more information about wellness, please see recent studies that Krill oil could improve muscle health in older people, and eating yogurt linked to lower frailty in older people.
Copyright © 2024 Knowridge Science Report. All rights reserved.
