More than 20 million people in the United States suffer from neuropathic pain, which happens when nerves are damaged or don’t work properly.
For about one out of every four people with this type of pain, doctors cannot figure out what’s causing it. These mysterious cases are called cryptogenic sensory polyneuropathy, or CSPN.
Because there is no clear cause, treating CSPN can be difficult. Doctors often have to guess which medication might work best. To help improve treatment, scientists from the University of Missouri recently carried out a large study to compare four common drugs used for treating nerve pain.
The study looked at 402 adults, all aged 30 or older, who were dealing with significant pain. These people rated their pain as at least a 4 out of 10, which means they were experiencing moderate to severe discomfort.
Each person was randomly assigned to take one of four different medications: nortriptyline, duloxetine, pregabalin, or mexiletine. These drugs all work in different ways. Nortriptyline is an older antidepressant. Duloxetine is a newer kind of antidepressant called an SNRI.
Pregabalin is often used to stop seizures and also helps with nerve pain. Mexiletine is normally used to treat irregular heartbeats but is sometimes used to ease nerve pain too.
Doctors followed the patients for 12 weeks to see how well each drug worked. They also watched to see how many people stopped taking the medication.
The results showed that nortriptyline helped the most, with 25% of patients feeling meaningful pain relief. It also had a moderate stop rate, with 38% of patients quitting the drug. Duloxetine was a close second, helping 23% of patients and having the lowest drop-out rate at 37%.
On the other hand, pregabalin helped only 15% of people, and mexiletine had the highest quit rate, with 58% of patients stopping the medication early.
None of the drugs worked for everyone, but overall, nortriptyline and duloxetine came out as the top options when looking at both how well they eased pain and how many people continued using them.
This suggests that doctors might want to consider trying nortriptyline or duloxetine first when treating patients with CSPN.
Other medications, like gabapentin and venlafaxine, are also used to treat nerve pain, as well as certain drugs that target sodium channels in nerves. The researchers believe future studies should take a closer look at these options too, to give doctors even more tools to help patients with unexplained nerve pain.
This research is a major step forward in understanding how to treat CSPN more effectively. Over time, with more studies, doctors may be able to follow clear guidelines that help their patients get better pain relief.
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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The study was published in JAMA Neurology and led by Dr. Richard Barohn and his team.
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