Neuropathic pain, a chronic and debilitating condition, affects over 20 million people in the United States. Among these cases, at least 25% fall under a type known as cryptogenic sensory polyneuropathy (CSPN), where the cause of the pain is unknown.
Treating CSPN is challenging because there is little information available to guide physicians in choosing the most effective medications.
Researchers from the University of Missouri recently conducted a study to compare the effectiveness of four commonly used drugs for managing CSPN.
The study involved 402 patients aged 30 or older who had been diagnosed with CSPN and reported moderate to severe pain, scoring four or higher on a 10-point pain scale.
The participants were randomly assigned to take one of four medications for 12 weeks:
- Nortriptyline: A tricyclic antidepressant
- Duloxetine: A serotonin-norepinephrine reuptake inhibitor
- Pregabalin: An anti-seizure drug
- Mexiletine: An anti-arrhythmic medication
The researchers assessed the participants’ responses at 4, 8, and 12 weeks, considering both how effective the drugs were in reducing pain and the dropout rates of patients due to side effects or other issues.
Among the four drugs, nortriptyline showed the best balance of effectiveness and tolerability. It had the highest success rate in relieving pain (25%) and the second-lowest quit rate (38%). Duloxetine came in second, with a slightly lower efficacy rate (23%) but the lowest dropout rate (37%).
Pregabalin, on the other hand, had the lowest efficacy rate at just 15%, while mexiletine had the highest dropout rate at 58%, making it the least favorable option overall.
The researchers noted that no single medication emerged as a clear winner for all patients.
However, nortriptyline and duloxetine performed better when considering both pain relief and tolerability, making them the recommended first options for treating CSPN.
The study also highlighted other non-narcotic medications, such as gabapentin, venlafaxine, and sodium channel inhibitors, which are sometimes used for similar conditions.
The researchers suggested further studies to compare these medications as well, aiming to provide doctors with more comprehensive data for treating neuropathic pain effectively.
This research is a significant step forward in helping physicians manage CSPN, a condition that often leaves patients struggling with unexplained and persistent pain.
By identifying medications that balance effectiveness with manageable side effects, the study provides valuable guidance for improving patients’ quality of life.
The study, led by Richard Barohn, was published in JAMA Neurology.
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