From the Guidelines
Treatment options for polyneuropathy should prioritize medications such as duloxetine (60-120 mg daily) or pregabalin (75-300 mg twice daily) to control neuropathic pain, as these have shown efficacy in recent studies 1. The goal of treatment is to address both the underlying cause and manage symptoms. Key considerations include:
- Medications:
- Duloxetine (60-120 mg daily)
- Pregabalin (75-300 mg twice daily)
- Gabapentin (300-1200 mg three times daily)
- Amitriptyline (10-100 mg at bedtime)
- Immunomodulating therapies for inflammatory polyneuropathies:
- Intravenous immunoglobulin (IVIG)
- Plasma exchange
- Corticosteroids
- Lifestyle modifications:
- Blood glucose control for diabetics
- Alcohol limitation
- Nutritional supplementation (particularly B vitamins)
- Additional pain relief options:
- Transcutaneous electrical nerve stimulation (TENS)
- Topical treatments like capsaicin or lidocaine patches Regular follow-up with healthcare providers is crucial to adjust therapy as needed and monitor for medication side effects, as treatment effectiveness varies by individual and underlying cause 1.
From the FDA Drug Label
Pregabalin is indicated for: Management of neuropathic pain associated with diabetic peripheral neuropathy Management of postherpetic neuralgia Adjunctive therapy for the treatment of partial-onset seizures in patients 1 month of age and older Management of fibromyalgia Management of neuropathic pain associated with spinal cord injury
The treatment options for polyneuropathy include pregabalin (PO), which is indicated for the management of neuropathic pain associated with diabetic peripheral neuropathy 2.
- Pregabalin has been shown to statistically significantly improve the endpoint mean pain score and increase the proportion of patients with at least a 50% reduction in pain score from baseline in patients with diabetic peripheral neuropathy 2.
- The recommended dose of pregabalin for the management of neuropathic pain associated with diabetic peripheral neuropathy is 100 mg or 200 mg three times a day 2.
- Pregabalin may be used in conjunction with other treatments, such as acetaminophen, for the management of pain associated with polyneuropathy 2.
From the Research
Treatment Options for Polyneuropathy
The treatment options for polyneuropathy can be categorized into several approaches, including pharmacologic and nonpharmacologic measures.
- Pharmacologic Treatments:
- First-line treatments for painful polyneuropathies include tricyclic antidepressants (TCAs), gabapentin, pregabalin, and serotonin noradrenaline reuptake inhibitors (SNRIs) 3.
- Second-line treatments are tramadol and other opioids 3.
- New types of treatment include botulinum toxin type A (BTX-A), high-dose capsaicin patches, and cannabinoids 3.
- For chronic inflammatory demyelinating polyneuropathy (CIDP), plasma exchange and intravenous immunoglobulin therapy are effective as induction treatments, and corticosteroid administration may be effective for both induction and maintenance 4, 5, 6.
- Nonpharmacologic Treatments:
- Exercise has emerged as an important therapeutic tool and may also improve the underlying polyneuropathy in the setting of obesity, metabolic syndrome, and diabetes 7.
Efficacy and Safety of Treatments
- The average pain reduction with available drugs is about 20-30%, and only 20-35% of the patients will achieve at least 50% pain reduction 3.
- Intravenous immunoglobulin (IVIg) compared with placebo increases the probability of significant improvement in disability within six weeks of the start of treatment, with a number needed to treat for an additional beneficial outcome (NNTB) of 4 5.
- IVIg probably has similar efficacy to oral prednisolone and intravenous methylprednisolone (IVMP) in improving disability 5.
- The frequency of serious adverse events may be higher with IVIg compared with IVMP 5.
- Gabapentinoids and SNRIs continue to have an advantage in safety profiles and efficacy for the management of painful polyneuropathies 7.