Neuropathic pain is a condition that affects over 20 million people in the United States. For many of them, the cause of the pain is unclear.
One common form of this mysterious pain is called cryptogenic sensory polyneuropathy (CSPN), which means doctors don’t know what’s causing the nerve damage that leads to pain.
Until now, there has been very little solid information to help doctors choose the best medication for treating CSPN. A new study from the University of Missouri set out to change that. The researchers wanted to compare the effectiveness of four commonly used drugs to find out which one works best for this condition.
The study included 402 adults aged 30 and older who had been diagnosed with CSPN and were experiencing moderate to severe pain. Each participant had a pain score of 4 or higher on a 10-point scale.
The participants were randomly assigned to take one of four medications: nortriptyline (an antidepressant), duloxetine (a drug that affects brain chemicals like serotonin and norepinephrine), pregabalin (an anti-seizure medicine), or mexiletine (a heart rhythm drug that is sometimes used for nerve pain).
The participants took their assigned drug for 12 weeks, and their pain levels were checked after four, eight, and 12 weeks.
Here’s what the researchers found. Nortriptyline was the most effective drug overall, with 25% of people who took it reporting a significant drop in their pain levels.
It also had the second-lowest drop-out rate—38% of participants stopped taking it before the study ended. This combination of effectiveness and better tolerance gave nortriptyline the highest overall score in the study.
Duloxetine came in close behind, with 23% of people reporting significant pain relief. Even better, it had the lowest drop-out rate at 37%, which suggests that people were more likely to stick with this medication.
On the other hand, pregabalin had the lowest effectiveness, helping only 15% of participants. Mexiletine had the highest drop-out rate, with 58% of users quitting the drug before the study was over. These results suggest that pregabalin and mexiletine may not be the best choices for treating CSPN.
While no single drug worked perfectly for everyone, the results show that nortriptyline and duloxetine are strong options that doctors might consider first when treating patients with CSPN.
The researchers also pointed out that more studies are needed. Other drugs, such as gabapentin, venlafaxine, and other types of sodium channel blockers, are also used to treat nerve pain but were not included in this study. Comparing those drugs in future research could give doctors even more useful information.
This important study was led by Dr. Richard Barohn and published in *JAMA Neurology*. It gives healthcare providers better guidance when treating a painful condition that has, until now, been hard to manage effectively.
If you care about pain, please read studies about Chronic morphine use for cancer pain may increase bone loss and findings of Scientists find a new hope for chronic pain.
For more information about pain, please read studies about What you need to know about diabetes and joint pain and findings of Understanding the connection between liver disease and joint pain.
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