More than 20 million people in the U.S. live with neuropathic pain, a type of pain caused by damaged nerves. One common type is called cryptogenic sensory polyneuropathy, or CSPN.
This condition causes nerve pain, often in the hands or feet, but doctors don’t know what causes it. That’s why it’s called “cryptogenic,” meaning “of unknown origin.”
CSPN is hard to treat because there haven’t been clear guidelines on which medications work best. To help solve this problem, researchers at the University of Missouri ran a study comparing four drugs that are often used to treat this kind of nerve pain. Their goal was to find out which ones help patients the most.
The study included 402 adults, age 30 and older, who had been diagnosed with CSPN. All of them rated their pain as at least a 4 out of 10. The participants were divided into four groups. Each group took one of these medications for 12 weeks: nortriptyline, duloxetine, pregabalin, or mexiletine.
Nortriptyline is an older antidepressant that is also used for pain. Duloxetine is a newer antidepressant that works on both serotonin and norepinephrine. Pregabalin is a drug used to treat seizures and nerve pain. Mexiletine is a heart medicine that can also help with pain.
Researchers checked in with the patients at 4, 8, and 12 weeks to see how they were doing. They looked at how much pain relief the patients experienced and how many people stopped taking the medication.
Nortriptyline helped the most, with 25% of patients feeling better. It also had a dropout rate of 38%, meaning 38% of people stopped taking it before the 12 weeks were up. Duloxetine was close behind, helping 23% of patients, and it had the lowest dropout rate at 37%. Pregabalin helped only 15% of people and mexiletine had the highest dropout rate at 58%.
None of the drugs worked for everyone, but nortriptyline and duloxetine seemed to offer the best balance between helping patients and being tolerable enough to keep taking.
Because of this, the researchers suggest doctors consider starting with nortriptyline or duloxetine when treating CSPN. These drugs seem to work better than the others and have fewer people quitting due to side effects.
There are also other non-opioid options for treating nerve pain, including gabapentin, venlafaxine, and other sodium channel blockers. The researchers believe more studies comparing these drugs would help doctors know even more about the best ways to treat CSPN.
The study was led by Dr. Richard Barohn and published in JAMA Neurology. It gives hope to people with unexplained nerve pain and helps guide doctors toward better treatment choices.
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