Randomized, Placebo-Controlled Comparison of Amitriptyline, Duloxetine, and Pregabalin in Patients With Chronic Diabetic Peripheral Neuropathic Pain

Boyle, Julia; Eriksson, Malin; Gribble, Laura; Gouni, R; Johnsen, Sigurd; Coppini, David; Kerr, David

doi:10.2337/dc12-0656

Cited by 211 publications

(150 citation statements)

References 34 publications

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“…Interestingly, a paper comparing the efficacy of neuralgia medications for diabetic neuropathy among patients randomized and placebo-controlled to receive amitriptyline, duloxetine, or pregabalin also found that no one medication emerged as superior (Boyle et al, 2012). …”

Section: Discussionmentioning

confidence: 99%

The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients

Bastian

2015

PeerJ

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Objective. This study sought to: (1) quantify response rate and efficacy of amitriptyline, desipramine, and gabapentin in treating sensory neuropathic cough; and (2) describe an efficient treatment protocol.Study Design. This study is a retrospective case series.Methods. Persons diagnosed with sensory neuropathic cough during a one-year period were potential study candidates. To bolster the diagnosis credibility, only persons who had been treated elsewhere for gastroesophageal reflux disease, asthma, and allergy with no reduction of cough were included. Upon diagnosis of sensory neuropathic cough, each person was treated with either amitriptyline, desipramine, or gabapentin, titrating the dose upward to desired benefit or the dose limit. If the benefit was insufficient, another of the medications was used next, using a similar dose escalation strategy. Data points included patient demographics, initial and final medication, final dose, and degree of improvement.Results. 32 patients met the diagnostic and inclusion criteria and had a complete data set. 94% (30 of 32) of the patients responded to at least one of the medications. The 32 patients undertook a total of 45 single-medication trials. Patients reported symptom relief during 78% (14 of 18) of amitriptyline trials, 73% (11 of 15) of desipramine trials, and 83% (10 of 12) of gabapentin trials. At final dosage, symptom reduction averaged 77% on amitriptyline, 73% on desipramine, and 69% on gabapentin.Conclusion. Amitriptyline, desipramine, and gabapentin appear to vary in their effectiveness for individual cases of sensory neuropathic cough; across a whole cohort, symptom relief was similar in frequency and degree on any of the three medications. More evidence is needed to demonstrate more convincingly the effectiveness of these medications, but this data set suggests that each of these three medications deserves consideration in the codified treatment protocol presented here.

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Section: Discussionmentioning

confidence: 99%

The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients

Bastian

2015

PeerJ

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“…The pharmacological treatments, with exception to those targeted to the glycemic control, are symptomatic, not focused on the pathophysiological mechanisms, limited by side effects [3,121] and by the development of tolerance [121] . A wide variety of drugs, used alone or in combination, has been shown to significantly reduce neuropathic pain compared with placebo in randomized controlled trials, but pain relief remains inadequate for most patients [122] .…”

Section: Treatment Of Dnpmentioning

confidence: 99%

Diabetic neuropathic pain: Physiopathology and treatment

Schreiber

Nones

Reis

et al. 2015

WJD

353

267

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Diabetic neuropathy is a common complication of both type 1 and type 2 diabetes, which affects over 90% of the diabetic patients. Although pain is one of the main symptoms of diabetic neuropathy, its pathophysiological mechanisms are not yet fully known. It is widely accepted that the toxic effects of hyperglycemia play an important role in the development of this complication, but several other hypotheses have been postulated. The management of diabetic neuropathic pain consists basically in excluding other causes of painful peripheral neuropathy, improving glycemic control as a prophylactic therapy and using medications to alleviate pain. First line drugs for pain relief include anticonvulsants, such as pregabalin and gabapentin and antidepressants, especially those that act to inhibit the reuptake of serotonin and noradrenaline. In addition, there is experimental and clinical evidence that opioids can be helpful in pain control, mainly if associated with first line drugs. Other agents, including for topical application, such as capsaicin cream and lidocaine patches, have also been proposed to be useful as adjuvants in the control of diabetic neuropathic pain, but the clinical evidence is insufficient to support their use. In conclusion, a better understanding of the mechanisms underlying diabetic neuropathic pain will contribute to the search of new therapies, but also to the improvement of the guidelines to optimize pain control with the drugs currently available.

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“…efficacy was observed between amitriptyline, duloxetine, and pregabalin. There were no significant safety results; however, in the pregabalin group there were a significantly higher number of adverse events (26). In a clinical trial, Tanenberg et al investigated three groups of patients with DPNP: duloxetine, pregabalin, and duloxetine plus gabapentin recipient groups.…”

Section: Discussionmentioning

confidence: 99%

Comparative Efficacy of Duloxetine Versus Nortriptyline in Patients with Diabetic Peripheral Neuropathic Pain: A Double Blind Randomized Controlled Trial

Zakerkish¹,

Amiri²,

Nasab³

et al. 2017

Iran Red Crescent Med J

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Background: Diabetic peripheral neuropathic pain (DPNP) is a common type of diabetic neuropathy. Blood sugar control is the first step for management of DPNP and drug treatment may be prescribed for the pain relief. Objectives: This study assessed the efficacy and safety of duloxetine and nortriptyline in patients with DPNP. Methods: This double-blind randomized clinical trial was conducted in the diabetes clinic of Golestan Hospital (Ahvaz, Iran). Convenience sampling and simple random allocation were used in the study. 134 patients with DPNP were randomly divided into two groups (67 patients in each group). The duloxetine group received 30 to 60 mg/day and nortriptyline group received 25 to 75 mg/day for a period of 6 weeks. Pain assessment was conducted based on a Visual analogue scale (VAS) and drug side effects were assessed on a weekly basis. Results: The study showed that both groups had significant reduction in pain severity at the end of the study (P < 0.05). The proportion of patients achieving 50% reduction in pain severity was significantly greater in the duloxetine group than the nortriptyline group (P < 0.05). The treatment side effects observed in the two groups were not significantly different (P = 0.298). Conclusions: Monotherapy with duloxetine and nortriptyline is safe and effective in the management of patients with DPNP.

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Randomized, Placebo-Controlled Comparison of Amitriptyline, Duloxetine, and Pregabalin in Patients With Chronic Diabetic Peripheral Neuropathic Pain

Cited by 211 publications

References 34 publications

The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients

The use of neuralgia medications to treat sensory neuropathic cough: our experience in a retrospective cohort of thirty-two patients

Diabetic neuropathic pain: Physiopathology and treatment

Comparative Efficacy of Duloxetine Versus Nortriptyline in Patients with Diabetic Peripheral Neuropathic Pain: A Double Blind Randomized Controlled Trial

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