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May 16, 2017; 88 (20) Views & Reviews

Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life

A systematic review

Julie M. Waldfogel, Suzanne Amato Nesbit, Sydney M. Dy, Ritu Sharma, Allen Zhang, Lisa M. Wilson, Wendy L. Bennett, Hsin-Chieh Yeh, Yohalakshmi Chelladurai, Dorianne Feldman, Karen A. Robinson
First published March 24, 2017, DOI: https://doi.org/10.1212/WNL.0000000000003882
Julie M. Waldfogel
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Suzanne Amato Nesbit
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Sydney M. Dy
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Ritu Sharma
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Allen Zhang
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Lisa M. Wilson
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Wendy L. Bennett
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Hsin-Chieh Yeh
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Yohalakshmi Chelladurai
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Dorianne Feldman
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Karen A. Robinson
From the Department of Pharmacy (J.M.W., S.A.N.), The Johns Hopkins Hospital; Department of Health Policy & Management (S.M.D., R.S., A.Z., L.M.W.), Johns Hopkins Bloomberg School of Public Health; Division of General Internal Medicine (W.L.B., K.A.R.) and Department of Physical Medicine & Rehabilitation (D.F.), Johns Hopkins University School of Medicine; Departments of Medicine, Epidemiology, and Oncology (H.-C.Y.), Division of General Internal Medicine, Johns Hopkins University, Baltimore, MD; and Department of Internal Medicine (Y.C.), Morehouse School of Medicine, Atlanta, GA.
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Citation
Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life
A systematic review
Julie M. Waldfogel, Suzanne Amato Nesbit, Sydney M. Dy, Ritu Sharma, Allen Zhang, Lisa M. Wilson, Wendy L. Bennett, Hsin-Chieh Yeh, Yohalakshmi Chelladurai, Dorianne Feldman, Karen A. Robinson
Neurology May 2017, 88 (20) 1958-1967; DOI: 10.1212/WNL.0000000000003882

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This article has a correction. Please see:

  • Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review - August 22, 2017
  • Article
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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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Letters: Rapid online correspondence

  • Response from author: Pharmacotherapy for diabetic peripheral neuropathy pain and quality of life: A systematic review
    • Julie M Waldfogel, Clinical Pharmacy Specialist, The Johns Hopkins Hospital
    • Lisa M Wilson, Research Coordinator, Johns Hopkins Bloomberg School of Public Health
    • Karen A Robinson, Associate Professor, Johns Hopkins Bloomberg School of Public Health
    Submitted March 07, 2018
  • Comment on Waldfogel et al.
    • Bruce Parsons, Pfizer Incbruce.parsons@pfizer.com
    • Diane Martire, Anamaria Jorga, Sean Donevan, New York
    Submitted December 21, 2017
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