From the Guidelines
For polyneuropathy pain, the most effective treatment is duloxetine, which has been shown to have a moderate clinical benefit in patients with painful chemotherapy-induced peripheral neuropathy (CIPN) 1.
Treatment Options
- Medications like gabapentin (300-1200mg three times daily) and pregabalin (75-300mg twice daily) can be considered for the treatment of neuropathic pain, as they have established efficacy for other forms of neuropathic pain 1.
- Duloxetine (30-60mg daily) is recommended for the treatment of neuropathic pain, with a higher rate of pain reduction found with duloxetine versus placebo (59% versus 38%) 1.
- Tricyclic antidepressants such as amitriptyline (10-75mg at bedtime) may have the potential for symptom control in patients with CIPN, but have lesser proven efficacy 1.
- Topical treatments like capsaicin patches (8%) can provide localized relief, with one small study in CIPN showing a moderate clinical benefit 1.
Important Considerations
- Non-medication approaches, such as physical therapy and transcutaneous electrical nerve stimulation (TENS), can provide temporary relief and help maintain strength and mobility.
- Blood sugar control is crucial for diabetic neuropathy patients, and regular follow-up with healthcare providers is essential to monitor progress and adjust treatment as needed.
- Opioids, such as tramadol, may be considered short-term for severe cases, but they carry addiction risks and have no compelling data to support their use specifically for CIPN 1.
- It is essential to start with lower medication doses and gradually increase to minimize side effects like dizziness and drowsiness, and to apply all suggested agents against neuropathic pain at least for 2 weeks at the appropriate dose to assess their efficacy before changing to another option 1.
From the FDA Drug Label
The efficacy of duloxetine delayed-release capsules for the management of neuropathic pain associated with diabetic peripheral neuropathy in adults was established in 2 randomized, 12-week, double-blind, placebo-controlled, fixed-dose trials in adult patients having diabetic peripheral neuropathic pain (DPNP) for at least 6 months (Study DPNP-1 and Study DPNP-2). Treatment with duloxetine delayed-release capsules 60 mg one or two times a day statistically significantly improved the endpoint mean pain scores from baseline and increased the proportion of patients with at least a 50% reduction in pain scores from baseline
Treatment for Polyneuropathy Pains:
- Duloxetine delayed-release capsules 60 mg once daily or 60 mg twice daily can be used to manage neuropathic pain associated with diabetic peripheral neuropathy.
- The medication has been shown to statistically significantly improve endpoint mean pain scores from baseline and increase the proportion of patients with at least a 50% reduction in pain scores from baseline 2.
From the Research
Treatment Options for Polyneuropathy Pains
- The treatment of polyneuropathy includes symptomatic therapy of sensory, motor, and autonomic dysfunctions, with a focus on pain management 3.
- Current treatment guidelines recommend calcium-channel anticonvulsants such as gabapentin/pregabalin, as well as antidepressants like duloxetine and amitriptyline, as first-line therapeutics 3, 4, 5, 6.
- Topical therapeutics can be used in cases of localized disorders, while opioids or other antidepressants/anticonvulsants may be effective in individual cases 3, 4, 6.
- Pharmacological treatment is often limited due to adverse events, particularly those affecting the central nervous system, and should be chosen based on comorbidities, patient age, and potential adverse events 3, 4, 6.
Specific Medications and Therapies
- Tricyclic antidepressants have been shown to be effective in treating pain in polyneuropathy, with a number needed to treat (NNT) of 2.6 4.
- Gabapentin, an anticonvulsant calcium channel blocker, has an NNT of 4.1, while tramadol, a mixed opioid and monoaminergic drug, has an NNT of 3.4 4.
- Duloxetine and pregabalin are recommended as first-line pharmacologic therapy for painful diabetic neuropathy, a type of polyneuropathy 5.
- Dorsal column spinal cord stimulation (SCS) has been shown to be effective in treating painful diabetic neuropathy, with level I evidence supporting its use 5.
Considerations for Treatment
- Treatment for polyneuropathy should follow a multimodal concept, including the treatment of other symptoms, and should be tailored to the individual patient's needs 3.
- Phenotype-based stratification may support specialized pain therapy and achieve the best medical treatment 3.
- Long-term studies, head-to-head comparisons, and studies of treatment combinations are a priority for future research on neuropathic pain treatment 6.