More than 20 million people in the U.S. suffer from neuropathic pain, which is pain caused by nerve damage. In at least one out of four cases, doctors can’t figure out the cause.
These cases are called cryptogenic sensory polyneuropathy (CSPN). Because the cause is unknown, treating CSPN is difficult, and doctors don’t always know which medication works best.
To help solve this problem, researchers at the University of Missouri did a large study to compare four common drugs used to treat CSPN. They wanted to find out which drug was most effective in reducing nerve pain.
The study involved 402 adults, all over the age of 30, who reported significant pain levels—at least 4 out of 10 on a pain scale. These patients were given one of four medications: nortriptyline, duloxetine, pregabalin, or mexiletine.
Each of these drugs works in a different way. Nortriptyline is an older antidepressant. Duloxetine is a newer type of antidepressant called an SNRI. Pregabalin is usually used to treat seizures, and mexiletine is a heart medicine that can also be used for nerve pain.
Over a 12-week period, doctors checked how well each drug worked to relieve pain and how many people continued or stopped the treatment.
The results showed that nortriptyline worked best. About 25% of the patients taking it said their pain got better. It also had a fairly low drop-out rate—only 38% of patients stopped taking it. Duloxetine came in second, helping 23% of patients and having the lowest quit rate of 37%.
Pregabalin helped just 15% of patients, and mexiletine had the highest quit rate—58% of people stopped using it.
None of the drugs worked well for everyone, but nortriptyline and duloxetine showed the most promise. Based on these findings, the researchers suggest doctors may want to try these two drugs first when treating CSPN.
Other medications, such as gabapentin, venlafaxine, and certain sodium channel blockers, are also sometimes used for nerve pain. The researchers say more studies should be done to test how well these work for CSPN.
This study is an important step in figuring out better treatments for unexplained nerve pain. As research continues, doctors may soon have clearer guidelines on how to help people with this difficult condition.
The study was published in JAMA Neurology and led by Dr. Richard Barohn and his team.
If you care about pain, please read studies about how to manage your back pain, and Krill oil could improve muscle health in older people.
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