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Best Pain Relievers for Diabetic Neuropathy

Posted by medconsumers on July 8, 2007

Several older drug classes were found to be superior to newer drugs for short-term pain relief for people with diabetic neuropathy, a painful nerve disorder that affects the legs. These findings came from a review of all relevant studies conducted by a Hong Kong team led by Man-chun Wong, a pain management nurse at United Christian Hospital, and published recently in the British Medical Journal Online First.

Wong and colleagues searched the published medical literature for all trials in which people with diabetic neuropathy had been randomly assigned to take either a drug or a placebo. Topical and oral drugs were included in the trial search as were prescription drugs and over-the-counter products. Only 25 trials were of high enough quality to be included in the review.

Wong and colleagues found that an older class of antidepressants called tricyclic antidepressants and an older class of anticonvulsants were best for short-term relief of pain. So are two opioids: OxyContin and Ultram. Tricyclic antidepressants were introduced in the 1950s, and have several brand names that include Tofranil, Elavil, Deprexan and Impril (Canada).

Anticonvulsants also provide pain relief for people with diabetic neuropathy, although the drugs are primarily intended to control seizures in epileptics. Wong and colleagues found the older anticonvulsants, such as Dilantin and Apo-Carbamazepine (Canada), approved in the 1930s and 1960s, respectively, to be superior to the newer anticonvulsants, such as Neurontin, approved in 1981.

The clinical trials included in this review typically lasted between two and 12 weeks. Wong and colleagues warned, “Evidence of the long-term effects of oral antidepressants and anticonvulsants is still lacking.”

Maryann Napoli, Center for Medical Consumers ©
July 2007

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