Most effective drugs for common type of neuropathic pain
Clinical study tested four different types of medications for efficacy, tolerability and adverse effects

Date:
October 15, 2020
Source:
University of Missouri-Columbia
Summary:
More than 20 million people in the U.S. suffer neuropathic
pain. At least 25% of those cases are classified as unexplained
and considered cryptogenic sensory polyneuropathy (CSPN). There is
no information to guide a physician's drug choices to treat CSPN,
but a researcher recently led a first-of-its-kind prospective
comparative effectiveness study.



FULL STORY ==========================================================================
More than 20 million people in the U.S. suffer neuropathic pain. At
least 25% of those cases are classified as unexplained and considered cryptogenic sensory polyneuropathy (CSPN). There is no information to
guide a physician's drug choices to treat CSPN, but a researcher from
the University of Missouri School of Medicine and MU Health Care led a first-of-its-kind prospective comparative effectiveness study.


==========================================================================
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 involved 40 sites and enrolled 402 patients with diagnosed CSPN who were 30 years or older and reported a
pain score of four or greater on a 10-point scale.

Participants were prescribed one of four medications commonly used to
treat CSPN: nortriptyline, a tricyclic antidepressant; duloxetine, a
serotonin- norepinephrine reuptake inhibitor; pregabalin, an anti-seizure
drug; or mexiletine, an anti-arrhythmic medication. Patients took the prescribed treatment for 12 weeks and were evaluated at four, eight and 12 weeks. Any participant who reported at least a 50% reduction in pain was
deemed as demonstrating an efficacious result. Patients who discontinued
the treatment drug because of adverse effects were also measured.

"This study went beyond whether the drug reduced pain to also focus on
adverse effects," said Richard Barohn, MD, lead researcher and executive
vice chancellor for health affairs at the University of Missouri. "As
the first study of its kind, we compared these four drugs in a real-life setting to provide physicians with a body of evidence to support the
effective management of peripheral neuropathy and to support the need for
newer and more effective drugs for neuropathic pain." Nortriptyline had
the highest efficacious percentage (25%), and the second- lowest quit rate (38%), giving it the highest level of overall utility.

Duloxetine had the second-highest efficacious rate (23%), and lowest
drop-out rate (37%). Pregbalin had the lowest efficacy rate (15%) and Mexiletene had the highest quit rate (58%).

"There was no clearly superior performing drug in the study," Barohn said.

"However, of the four medications, nortriptyline and duloxetine performed better when efficacy and dropouts were both considered. Therefore, we
recommend that either nortriptyline or duloxetine be considered before
the other medications we tested." There are other nonnarcotic drugs used
to treat painful peripheral neuropathy, including gabapentin, venlafaxine
and other sodium channel inhibitors. Barohn said additional comparative effectiveness research studies can be performed on those drugs, so doctors
can further build a library of data for the treatment of CSPN. His goal
is to build effectiveness data on nearly a dozen drugs for CSPN.


========================================================================== Story Source: Materials provided by University_of_Missouri-Columbia. Note: Content may be edited for style and length.


========================================================================== Journal Reference:
1. Richard J. Barohn, Byron Gajewski, Mamatha Pasnoor, Alexandra Brown,
Laura L. Herbelin, Kim S. Kimminau, Dinesh Pal Mudaranthakam,
Omar Jawdat, Mazen M. Dimachkie, Stanley Iyadurai, Amro Stino, John
Kissel, Robert Pascuzzi, Thomas Brannagan, Matthew Wicklund, Aiesha
Ahmed, David Walk, Gordon Smith, Dianna Quan, Darryl Heitzman,
Alejandro Tobon, Shafeeq Ladha, Gil Wolfe, Michael Pulley, Ghazala
Hayat, Yuebing Li, Pariwat Thaisetthawatkul, Richard Lewis, Suur
Biliciler, Khema Sharma, Kian Salajegheh, Jaya Trivedi, William
Mallonee, Ted Burns, Mark Jacoby, Vera Bril, Tuan Vu, Sindhu
Ramchandren, Mark Bazant, Sara Austin, Chafic Karam, Yessar Hussain,
Christen Kutz, Paul Twydell, Stephen Scelsa, Hani Kushlaf, James
Wymer, Michael Hehir, Noah Kolb, Jeffrey Ralph, Alexandru Barboi,
Navin Verma, Moiz Ahmed, Anza Memon, David Saperstein, Jau-Shin Lou,
Andrea Swenson, Tiyonnoh Cash. Patient Assisted Intervention for
Neuropathy: Comparison of Treatment in Real Life Situations (PAIN-
CONTRoLS). JAMA Neurology, 2020; DOI: 10.1001/jamaneurol.2020.2590 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/10/201015173129.htm

--- up 7 weeks, 3 days, 6 hours, 50 minutes
* Origin: -=> Castle Rock BBS <=- Now Husky HPT Powered! (1337:3/111)