More than 20 million people in the U.S. suffer from neuropathic pain, a condition that causes nerve damage and discomfort. For many of these patients, doctors can find a clear cause, such as diabetes or an injury. But for at least a quarter of cases, the cause remains a mystery.
This unexplained nerve pain is called cryptogenic sensory polyneuropathy (CSPN). Since doctors don’t know what causes it, finding the right treatment is difficult. To help, researchers at the University of Missouri recently conducted a large study to compare four commonly used medications and see which one works best.
How the Study Was Done
The study included 402 patients, all aged 30 or older, who had severe nerve pain (rated at least 4 out of 10 on a pain scale). Each person was given one of four medications:
- Nortriptyline – A type of antidepressant
- Duloxetine – A drug that affects serotonin and norepinephrine levels
- Pregabalin – A medication used for nerve pain and seizures
- Mexiletine – A drug usually used for heart rhythm problems but sometimes for nerve pain
The patients took the medications for 12 weeks, while doctors monitored how well their pain improved and how many people stopped taking the drugs due to side effects or lack of relief.
What the Study Found
Some medications worked better than others, but none were perfect. The results showed:
- Nortriptyline was the most effective, helping 25% of patients reduce their pain. It also had a quit rate of 38%.
- Duloxetine was the second-best, helping 23% of patients, with the lowest quit rate (37%).
- Pregabalin was the least effective, helping only 15% of patients.
- Mexiletine had the highest drop-out rate, with 58% of patients stopping the medication.
Although no single drug worked for everyone, the study suggests that nortriptyline and duloxetine might be the best first options for treating CSPN.
What This Means for Patients
Right now, there is no clear treatment plan for CSPN, making it frustrating for patients and doctors. This study gives doctors better guidance on where to start when choosing medications.
Other drugs, like gabapentin and venlafaxine, are also used for nerve pain, but more research is needed to compare their effectiveness. The researchers hope that with more studies, doctors will soon have better guidelines to help patients manage CSPN.
This study, led by Dr. Richard Barohn, was published in JAMA Neurology and marks an important step in improving treatment options for people suffering from unexplained nerve pain.
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.
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