Michael Tanner, MD, FACP
What is the effectiveness of drugs for reducing pain in patients with painful diabetic neuropathy (PDN)?
Included studies evaluated clearly described treatments for PDN, reported study completion rates, and clearly described outcome measures. Main outcome was reduction of pain. Reviews and case reports were excluded.
MEDLINE and EMBASE/Excerpta Medica (to Aug 2008) were searched for relevant studies. 78 articles met the selection criteria; 67 evaluated drugs, and 11 evaluated nondrug treatments. Only results for studies evaluating drugs are reported here. Based on American Academy of Neurology 4-level classification of evidence criteria, 14 studies were class I (randomized controlled trials [RCTs] meeting prespecified quality criteria), 29 class II (other RCTs or prospective, matched cohort studies), 23 class III (other controlled studies), and 1 study included class II and class III data.
The main results for pain reduction are in the Table.
Based on class I evidence, pregabalin reduces pain in painful diabetic neuropathy; other drug treatments may reduce pain.
*CR = controlled release; RCT = randomized controlled trial; other abbreviations defined in Glossary. Only comparisons including > 1 class I or class II study are reported here.
†Based on American Academy of Neurology classification of evidence criteria: class I = RCTs meeting prespecified quality criteria; class II = other RCTs and prospective, matched cohort studies.
‡Pain reduction assessed using Likert scales or visual analogue scales unless reported otherwise.
§2 studies reported in 1 article.
||Pain was not a prespecified outcome.
Tanner M. Review: Pregabalin and other drugs reduce pain in patients with painful diabetic neuropathy. Ann Intern Med. ;155:JC5–8. doi: 10.7326/0003-4819-155-10-201111150-02008
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Published: Ann Intern Med. 2011;155(10):JC5-8.
Cardiology, Coronary Risk Factors, Diabetes, Endocrine and Metabolism, Neurology.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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