The efficacy of monotherapy to reduce diabetic peripheral neuropathy (DPN) pain is still not satisfactory and guidelines do not provide consistent treatment options. Henceforth, multiple drug pharmacotherapy may be useful.

A recent study reviewed the clinical trials evaluating the pharmacotherapy in painful DPN, discussed studies investigating the efficacy and tolerability of pharmacological agents (both monotherapy and in combination), and made conclusions that-

• In the treatment of DPN pain, monotherapy is often suboptimal and/or associated with significant adverse effects.
• In the majority of cases, multi-drug therapy is effective, but it is often restricted by untoward effects.
• Some subjects with painful DPN may benefit more from a combination treatment, while others may benefit from high-dose monotherapy.
• DPN pain can be improved with oxycodone plus pregabalin and pregabalin plus 5% lidocaine plaster combinations.
• Multiple drug pharmacotherapies for the treatment of painful DPN need to be evaluated carefully in RCTs to determine their cost-effectiveness and if they should be implemented or rejected in lieu of single agents.

Pafili K, Papanas N. Considerations for single- versus multiple-drug pharmacotherapy in the management of painful diabetic neuropathy, Expert Opinion on Pharmacotherapy. 2021;22(16):2267-2280. DOI: 10.1080/14656566.2021.1909570