CNS Update: Pharmacological Management of Painful Peripheral Neuropathies


eMediNexus    23 February 2023

Peripheral neuropathic pain (PNP) can be either acute or occur in the chronic phase of a lesion or disease of the peripheral nervous system. It carries a substantial disease burden with challenging management options.


A recent study evaluated current evidence derived from randomized controlled trials (RCTs) that assessed pharmacological interventions for treating PNP due to polyneuropathy (PN).


It searched the PubMed database and sorted 538 papers. After scrutinizing all the articles, it ultimately included 83 papers for the systematic review.


The study found the best evidence for managing painful diabetic polyneuropathy (DPN) with amitriptyline, duloxetine, gabapentin, Pregabalin and venlafaxine as monotherapies along with oxycodone as add-on therapy. Tramadol represented an effective monotherapy and add-on therapy in patients with PN of various etiologies. Several other agents showed weaker evidence for their effectiveness in managing PNP due to PN.


Thus, Response to treatment may differ according to the underlying pathophysiological mechanisms involved in the pathogenesis of the PN; therefore, it is crucial to thoroughly investigate patients presenting with PNP to determine the causes of this neuropathy. 


Amitriptyline, duloxetine, gabapentin, Pregabalin and venlafaxine can be regarded best for managing painful diabetic polyneuropathy.


Pain Ther. 2021;10:55–68. https://doi.org/10.1007/s40122-020-00210-3


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