Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life

Julie M. Waldfogel, Suzanne Amato Nesbit, Sydney E Dy, Ritu Sharma, Allen Zhang, Lisa Wilson, Wendy Bennett, Hsin Chieh Yeh, Yohalakshmi Chelladurai, Dorianne R Feldman, Karen A Robinson

Research output: Contribution to journalReview article

Abstract

Objective: To systematically assess the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. Methods: We searched PubMed and Cochrane Database of Systematic Reviews for systematic reviews from 2011 to October 12, 2015, and PubMed, Embase, and the Cochrane Central Register of Controlled Trials for primary studies from January 1, 2013, to May 24, 2016. We searched Clinicaltrials.gov on March 9, 2016. Two reviewers independently evaluated studies for eligibility, serially abstracted data, and independently evaluated risk of bias and graded strength of evidence (SOE). Results: We updated a recently completed systematic review of 57 eligible studies with 24 additional published studies and 25 unpublished studies. For reducing neuropathy-related pain, the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine (moderate SOE), the anticonvulsants pregabalin and oxcarbazepine (low SOE), the drug classes tricyclic antidepressants (low SOE) and atypical opioids (low SOE), and botulinum toxin (low SOE) were more effective than placebo. We could not draw conclusions about quality of life due to incomplete reporting. All studies were short-term (less than 6 months), and all effective drugs had more than 9% dropouts from adverse effects. Conclusions: For reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks. Future studies should evaluate longer-term outcomes, use methods and measures recommended by pain organizations, and assess patients' quality of life.

Original languageEnglish (US)
Pages (from-to)1958-1967
Number of pages10
JournalNeurology
Volume88
Issue number20
DOIs
StatePublished - May 16 2017

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Diabetic Neuropathies
Peripheral Nervous System Diseases
Quality of Life
Opioid Analgesics
Drug Therapy
Pain
Botulinum Toxins
Tricyclic Antidepressive Agents
PubMed
Placebos
Pharmaceutical Preparations
Anticonvulsants
Organizations
Databases
Venlafaxine Hydrochloride
Duloxetine Hydrochloride
Pregabalin
oxcarbazepine
Therapeutics

ASJC Scopus subject areas

  • Clinical Neurology

Cite this

Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. / Waldfogel, Julie M.; Nesbit, Suzanne Amato; Dy, Sydney E; Sharma, Ritu; Zhang, Allen; Wilson, Lisa; Bennett, Wendy; Yeh, Hsin Chieh; Chelladurai, Yohalakshmi; Feldman, Dorianne R; Robinson, Karen A.

In: Neurology, Vol. 88, No. 20, 16.05.2017, p. 1958-1967.

Research output: Contribution to journalReview article

Waldfogel, Julie M. ; Nesbit, Suzanne Amato ; Dy, Sydney E ; Sharma, Ritu ; Zhang, Allen ; Wilson, Lisa ; Bennett, Wendy ; Yeh, Hsin Chieh ; Chelladurai, Yohalakshmi ; Feldman, Dorianne R ; Robinson, Karen A. / Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life. In: Neurology. 2017 ; Vol. 88, No. 20. pp. 1958-1967.
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AU - Waldfogel, Julie M.

AU - Nesbit, Suzanne Amato

AU - Dy, Sydney E

AU - Sharma, Ritu

AU - Zhang, Allen

AU - Wilson, Lisa

AU - Bennett, Wendy

AU - Yeh, Hsin Chieh

AU - Chelladurai, Yohalakshmi

AU - Feldman, Dorianne R

AU - Robinson, Karen A

PY - 2017/5/16

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N2 - Objective: To systematically assess the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. Methods: We searched PubMed and Cochrane Database of Systematic Reviews for systematic reviews from 2011 to October 12, 2015, and PubMed, Embase, and the Cochrane Central Register of Controlled Trials for primary studies from January 1, 2013, to May 24, 2016. We searched Clinicaltrials.gov on March 9, 2016. Two reviewers independently evaluated studies for eligibility, serially abstracted data, and independently evaluated risk of bias and graded strength of evidence (SOE). Results: We updated a recently completed systematic review of 57 eligible studies with 24 additional published studies and 25 unpublished studies. For reducing neuropathy-related pain, the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine (moderate SOE), the anticonvulsants pregabalin and oxcarbazepine (low SOE), the drug classes tricyclic antidepressants (low SOE) and atypical opioids (low SOE), and botulinum toxin (low SOE) were more effective than placebo. We could not draw conclusions about quality of life due to incomplete reporting. All studies were short-term (less than 6 months), and all effective drugs had more than 9% dropouts from adverse effects. Conclusions: For reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks. Future studies should evaluate longer-term outcomes, use methods and measures recommended by pain organizations, and assess patients' quality of life.

AB - Objective: To systematically assess the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life. Methods: We searched PubMed and Cochrane Database of Systematic Reviews for systematic reviews from 2011 to October 12, 2015, and PubMed, Embase, and the Cochrane Central Register of Controlled Trials for primary studies from January 1, 2013, to May 24, 2016. We searched Clinicaltrials.gov on March 9, 2016. Two reviewers independently evaluated studies for eligibility, serially abstracted data, and independently evaluated risk of bias and graded strength of evidence (SOE). Results: We updated a recently completed systematic review of 57 eligible studies with 24 additional published studies and 25 unpublished studies. For reducing neuropathy-related pain, the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine (moderate SOE), the anticonvulsants pregabalin and oxcarbazepine (low SOE), the drug classes tricyclic antidepressants (low SOE) and atypical opioids (low SOE), and botulinum toxin (low SOE) were more effective than placebo. We could not draw conclusions about quality of life due to incomplete reporting. All studies were short-term (less than 6 months), and all effective drugs had more than 9% dropouts from adverse effects. Conclusions: For reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks. Future studies should evaluate longer-term outcomes, use methods and measures recommended by pain organizations, and assess patients' quality of life.

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