Examine reveals simplest medicine for widespread kind of neuropathic ache
Richard Barohn, MD is the Senior Researcher and Executive Vice Chancellor of Health at the University of Missouri. Credit: Justin Kelley
Neuropathic pain affects more than 20 million people in the United States. At least 25% of these cases are classified as unexplained and classified as cryptogenic sensory polyneuropathy (CSPN). There is no information to guide a physician’s drug selection for treating CSPN, but a researcher from the University of Missouri Medical School and MU Health Care conducted an initial prospective comparative efficacy study of its kind.
The study compared four drugs with different mechanisms of action in a large group of patients with CSPN to determine which drugs are most useful for this condition. The study spanned 40 sites and included 402 patients diagnosed with CSPN who were 30 years of age or older and reported a pain score of four or more on a 10-point scale.
Participants were prescribed one of four drugs commonly used to treat CSPN: nortriptyline, a tricyclic antidepressant; Duloxetine, a serotonin-norepinephrine reuptake inhibitor; Pregabalin, an anti-seizure drug; or mexiletine, an antiarrhythmic. Patients took the prescribed treatment for 12 weeks and were examined at four, eight and 12 weeks. Any participant who reported a pain reduction of at least 50% was considered an effective result. Patients who discontinued the drug because of side effects were also measured.
“This study went beyond whether the drug relieved pain to focus on side effects as well,” said Dr. Richard Barohn, Senior Researcher and Assistant Vice Chancellor for Health at the University of Missouri. “As the first of its kind, we compared these four drugs in a real-world setting to provide doctors with a set of evidence to support effective management of peripheral neuropathy and the need for new and more effective drugs for neuropathic pain.”
Nortriptyline had the highest effective percentage (25%) and the second lowest dropout rate (38%), which gives it the highest overall utilization rate. Duloxetine had the second highest effectiveness rate (23%) and the lowest dropout rate (37%). Pregbalin had the lowest effectiveness rate (15%) and Mexiletene had the highest withdrawal rate (58%).
“There was no clearly superior drug in the study,” said Barohn. “Of the four drugs, however, nortriptyline and duloxetine performed better when both efficacy and dropouts were taken into account. Therefore, we recommend considering either nortriptyline or duloxetine before the other drugs we tested.”
There are other non-narcotic drugs used to treat painful peripheral neuropathy, including gabapentin, venlafaxine, and other sodium channel inhibitors. Barohn said additional comparative efficacy research studies can be conducted on these drugs so that clinicians can build another library of data for the treatment of CSPN. His goal is to compile efficacy data on nearly a dozen drugs for CSPN.
The study “Patient Assisted Intervention in Neuropathy: Comparing Treatment in Real Situations (PAIN-CONTROLS)” was recently published by JAMA Neurology.
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Richard J. Barohn et al., Patient Assisted Intervention in Neuropathy: Comparing Treatment in Real Situations (PAIN-CONTROLS), JAMA Neurology (2020). DOI: 10.1001 / jamaneurol.2020.2590 Provided by the University of Missouri
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