Painful Diabetic Neuropathy: Many Similarly Effective Therapies With Widely Dissimilar Costs
Authors: Brian C. Callaghan, Eva L. Feldman
Journal: Annals of Internal Medicine (2014)

Editorials4 November 2014Painful Diabetic Neuropathy: Many Similarly Effective Therapies With Widely Dissimilar CostsBrian C. Callaghan, MD, MS and Eva L. Feldman, MD, PhDBrian C. Callaghan, MD, MSFrom University of Michigan, Ann Arbor, Michigan. and Eva L. Feldman, MD, PhDFrom University of Michigan, Ann Arbor, Michigan.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/M14-2157 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail In this issue, Griebeler and colleagues (1) present important data on the comparative effectiveness of medications for the treatment of painful diabetic neuropathy by using a network meta-analysis approach. In concert with systematic reviews published by the American Academy of Neurology and the European Federation of Neurological Societies (2, 3), they found that anticonvulsants, serotonin–norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), and topical capsaicin 0.075% are better than placebo for short-term pain control. Unfortunately, few head-to-head studies compare these treatments, which is why Griebeler and colleagues used a network meta-analysis to indirectly compare drug classes. Although they found that SNRIs ...References1. Griebeler ML, Morey-Vargas OL, Brito JP, Tsapas A, Wang Z, CarranzaLeon BG, et al. Pharmacologic interventions for painful diabetic neuropathy. An umbrella systematic review and comparative effectiveness network meta-analysis. Ann Intern Med. 2014;161:639-49. doi:10.7326/M14-0511 LinkGoogle Scholar2. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, et al; European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17:1113-e88. [PMID: 20402746] doi:10.1111/j.1468-1331.2010.02999.x CrossrefMedlineGoogle Scholar3. Bril V, England J, Franklin GM, Backonja M, Cohen J, DelToro D, et al; American Academy of Neurology. Evidence-based guideline: treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2011;76:1758-65. [PMID: 21482920] doi:10.1212/WNL.0b013e3182166ebe CrossrefMedlineGoogle Scholar4. Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010;150:573-81. [PMID: 20705215] doi:10.1016/j.pain.2010.06.019 CrossrefMedlineGoogle Scholar5. Hamer M, Batty GD, DavidBatty G, Seldenrijk A, Kivimaki M. 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Abbott CA, Malik RA, vanRoss ER, Kulkarni J, Boulton AJ. Prevalence and characteristics of painful diabetic neuropathy in a large community-based diabetic population in the U.K. Diabetes Care. 2011;34:2220-4. [PMID: 21852677] doi:10.2337/dc11-1108 CrossrefMedlineGoogle Scholar10. Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43:817-24. [PMID: 8469345] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Michigan, Ann Arbor, Michigan.Financial Support: Dr. Callaghan is supported by the Katherine Rayner Program, the Taubman Medical Institute, and the National Institutes of Health/National Institute of Neurological Disorders and Stroke K23 award. Dr. Feldman is supported by the Taubman Medical Institute and National Institute of Neurological Disorders grants DP3DK094292 and R24 082841.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M14-2157.Corresponding Author: Brian C. Callaghan, MD, MS, A. Alfred Taubman Biomedical Science Research Building, 109 Zina Pitcher Place, 4021 BSRB, Ann Arbor, MI 48104; e-mail, [email protected]umich.edu.Current Author Addresses: Drs. Callaghan and Feldman: A. Alfred Taubman Biomedical Science Research Building, 109 Zina Pitcher Place, 4021 BSRB, Ann Arbor, MI 48104. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoPharmacologic Interventions for Painful Diabetic Neuropathy Marcio L. Griebeler , Oscar L. Morey-Vargas , Juan P. Brito , Apostolos Tsapas , Zhen Wang , Barbara G. Carranza Leon , Olivia J. Phung , Victor M. Montori , and M. Hassan Murad Pharmacologic Interventions for Painful Diabetic Neuropathy Marcio L. Griebeler , Oscar L. Morey-Vargas , Juan P. Brito , Apostolos Tsapas , Zhen Wang , Barbara G. Carranza Leon , Olivia J. Phung , Victor M. Montori , and M. Hassan Murad Metrics Cited byPhase 2a randomized controlled study investigating the safety and efficacy of PDA ‐002 in diabetic peripheral neuropathyComparison of efficacy and safety of gabapentin and duloxetine in painful diabetic peripheral neuropathy: A systematic review and meta‐analysis of randomised controlled trialsDiabetic neuropathyOut-of-pocket costs are on the rise for commonly prescribed neurologic medicationsPeripheral NeuropathyDisorders of mitochondrial dynamics in peripheral neuropathy: Clues from hereditary neuropathy and diabetesOvercoming barriers to diabetic polyneuropathy management in primary careNew Horizons in Diabetic Neuropathy: Mechanisms, Bioenergetics, and PainUpdates in diabetic peripheral neuropathy 4 November 2014Volume 161, Issue 9Page: 674-675KeywordsAnticonvulsantsDrugsForecastingNetwork analysisNeurologyNeuropathic painNeuropathyReuptake inhibitorsSystematic reviews ePublished: 4 November 2014 Issue Published: 4 November 2014 Copyright & PermissionsCopyright © 2014 by American College of Physicians. 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