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Abstract
Objective: To systematically assess the effect of pharmacologic treatments of diabetic peripheral neuropathy (DPN) on pain and quality of life.
Methods: We searched PubMed and Cochrane Database of Systematic Reviews for systematic reviews from 2011 to October 12, 2015, and PubMed, Embase, and the Cochrane Central Register of Controlled Trials for primary studies from January 1, 2013, to May 24, 2016. We searched Clinicaltrials.gov on March 9, 2016. Two reviewers independently evaluated studies for eligibility, serially abstracted data, and independently evaluated risk of bias and graded strength of evidence (SOE).
Results: We updated a recently completed systematic review of 57 eligible studies with 24 additional published studies and 25 unpublished studies. For reducing neuropathy-related pain, the serotonin-norepinephrine reuptake inhibitors duloxetine and venlafaxine (moderate SOE), the anticonvulsants pregabalin and oxcarbazepine (low SOE), the drug classes tricyclic antidepressants (low SOE) and atypical opioids (low SOE), and botulinum toxin (low SOE) were more effective than placebo. We could not draw conclusions about quality of life due to incomplete reporting. All studies were short-term (less than 6 months), and all effective drugs had more than 9% dropouts from adverse effects.
Conclusions: For reducing pain, duloxetine and venlafaxine, pregabalin and oxcarbazepine, tricyclic antidepressants, atypical opioids, and botulinum toxin were more effective than placebo. However, quality of life was poorly reported, studies were short-term, drugs had substantial dropout rates, and opioids have significant risks. Future studies should evaluate longer-term outcomes, use methods and measures recommended by pain organizations, and assess patients' quality of life.
GLOSSARY
- CI=
- confidence interval;
- CrI=
- credible interval;
- DPN=
- diabetic peripheral neuropathy;
- FDA=
- Food and Drug Administration;
- QOL=
- quality of life;
- RCT=
- randomized controlled trial;
- ROBIS=
- Risk of Bias in Systematic Reviews;
- SF-36=
- Short Form–36;
- SMD=
- standardized mean differences;
- SNRI=
- serotonin and norepinephrine reuptake inhibitor;
- SOE=
- strength of evidence;
- TCA=
- tricyclic antidepressant
Footnotes
Go to Neurology.org for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.
Data within this review are published simultaneously in a report by the Agency for Healthcare Research and Quality and Neurology®.
Supplemental data at Neurology.org
- Received December 5, 2016.
- Accepted in final form March 3, 2017.
- © 2017 American Academy of Neurology
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- Response from author: Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review
- Comment on Waldfogel et al.
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