Treating Diabetic Nerve Pain, Tingling, Numbness: New Recommendations

Guidance Offered to Clinicians on Treatment of Diabetic Peripheral Neuropathy and Call for Additional Research

The Agency for Healthcare Research and Quality (AHRQ), the lead federal agency charged with improving patient safety and healthcare quality, has published new findings on the effectiveness of some antidepressants, antiseizure drugs, and other medications in treating diabetic peripheral neuropathy. The findings, led by researchers at Johns Hopkins Hospital, Baltimore, were also published online last week in Neurology®. The findings emanate from a systematic review of 106 studies conducted since the 2011 guideline on treatment of painful diabetic neuropathy released by the American Academy of Neurology. The CDC estimates that one-half of US patients with diabetes suffer from DPN in some form, with symptoms including nerve pain, and tingling and numbness in the hands and feet.

The analysis found moderate evidence for the effectiveness of the antidepressants duloxetine and venlaxine, as well as weak evidence for botulinum toxin, and the antiseizure drugs pregabalin and oxcarbazepine in reducing pain from diabetic neuropathy. They reported that some tricyclic antidepressants and some atypical opioids might also be effective, while cautioning on concerns surrounding the benefits of long-term opioid therapy. The meta-analysis additionally concludes that 2 medications, valproate and capsaicin cream, which had been recommended in the 2011 guideline, were probably not effective as pain therapy. Lead author Julie Waldfogel, PharmD, cautioned, “Unfortunately, more research is still needed, as the current treatments have substantial risk of side effects, and few studies have been done on the long-term effects of these drugs.”

Read more about the recommendations here.

The report from AHRQ may be accessed here.

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