Research on Painful Diabetic Peripheral Neuropathy Therapies Shows Promise, Limitations

the MPR take:

Treatments are available for painful diabetic peripheral neuropathy, but how do they compare with efficacy? A review in the Annals of Internal Medicine evaluated 65 randomized controlled trials from January 2007 to April 2014 of 12,632 patients on 27 pharmacologic interventions for adults with painful diabetic peripheral neuropathy. In nine head-to-head trials, greater pain reduction was associated with serotonin-norepinephrine reuptake inhibitors (SNRIs) vs. anticonvulsants and with tricyclic antidepressants (TCAs) vs. topical capsaicin 0.075%. SNRIs, topical capsaicin, TCAs, and anticonvulsants were found to be superior to placebo for short-term pain control, particularly carbamazepine, venlafaxine, duloxetine, and amitriptyline. However, confidence in the findings was limited due to the fact that most evidence was obtained from indirect comparisons of trials with short (≤3 months) follow-up and half the studies had high or unclear risk of bias. These medication may provide short-term relief of painful diabetic neuropathy, but additional comparative studies are necessary for stronger evidence.

Data Sources: Multiple electronic databases between January 2007 and April 2014, without language restriction. Nine head-to-head trials showed greater pain reduction associated with serotonin-norepinephrine reuptake inhibitors (SNRIs) than anticonvulsants (standardized mean difference [SMD], 0.34 [95% credible interval {CrI}, 0.63 to 0.05]) and with tricyclic antidepressants (TCAs) than topical capsaicin 0.075%.