From the Guidelines
Currently, there are no new nerve growth treatments that have been proven to be highly effective for patients with peripheral polyneuropathy, and treatment approaches should focus on reduction or relief of neuropathic pain. Several medications such as duloxetine, venlafaxine, pregabalin, amitriptyline, tramadol, or strong opioids can be considered for the treatment of neuropathic pain 1. Additionally, physical exercise and functional training, such as vibration training, can reduce CIPN symptoms and are therefore recommended 1. Topical low-concentration menthol cream can also be considered as a local intervention for patients with CIPN 1.
Some studies suggest that acetyl-L-carnitine (ALC) supplements and alpha-lipoic acid may have modest benefits for nerve regeneration, particularly in diabetic and chemotherapy-induced neuropathy, however, the evidence is not strong enough to make a definitive recommendation 1. Electrical stimulation therapy and stem cell therapy are also being investigated, but these treatments remain largely experimental and lack FDA approval specifically for polyneuropathy.
- Key considerations for treatment include:
- Reduction or relief of neuropathic pain
- Improvement of quality of life
- Minimization of medication side effects
- Tailored and stepwise pharmacological strategy
- Careful attention to relative symptom improvement and medication adherence
- Medications that can be considered for treatment of neuropathic pain include:
- Duloxetine
- Venlafaxine
- Pregabalin
- Amitriptyline
- Tramadol
- Strong opioids
- Non-pharmacological interventions that can be considered include:
- Physical exercise and functional training
- Topical low-concentration menthol cream
- Electrical stimulation therapy
- Stem cell therapy (although this remains largely investigational)
From the Research
Nerve Growth Treatments for Peripheral Polyneuropathy
There are several treatments available for peripheral polyneuropathy, including:
- Medications such as pregabalin, gabapentin, and duloxetine to manage pain and other symptoms 2, 3, 4, 5
- Substitution of gabapentin therapy with pregabalin therapy in neuropathic pain due to peripheral neuropathy 6
Efficacy of Pregabalin
Pregabalin has been shown to be effective in reducing pain intensity in patients with postherpetic neuralgia, painful diabetic neuropathy, and mixed or unclassified post-traumatic neuropathic pain 4
- More participants had at least 30% pain intensity reduction with pregabalin 300 mg than with placebo
- More participants had at least 50% pain intensity reduction with pregabalin 600 mg than with placebo
Safety Profile
The safety profile of pregabalin and other treatments for diabetic peripheral neuropathic pain has been reviewed, with common side effects including dizziness, somnolence, and peripheral edema 3, 5
- Serious adverse events were no more common with pregabalin than with placebo
Substitution of Gabapentin with Pregabalin
Substitution of pregabalin for gabapentin therapy in neuropathic pain due to peripheral neuropathy has been shown to provide additional pain relief and possible improvement in quality of life 6
- Both gabapentin responder and nonresponder groups had additional neuropathic pain relief of about 25% following substitution of pregabalin after 6 and 12 months