Neuropathic pain, or pain caused by damage to the nervous system, can be difficult to treat. It’s not as well understood as other types of pain, like what you feel when you break a leg or have an abscessive tooth.

Researchers at the University of Kansas City Medical Center, Kansas City, looked at four commonly prescribed drugs for treating cryptogenic sensory polyneuropathy to see which ones might work best. Your findings? Two of the four drugs should be viewed as initial treatment.

What are Neuropathic Pain and Cryptogenic Sensory Polyneuropathy?

Neuropathic pain occurs when the nervous system fails or is damaged. Peripheral neuropathic pain, also called peripheral neuropathy, affects the peripheral nerves that are located outside of the spinal cord or brain.

More than 20 million people in the US have some type of neuropathic pain, often described as a burning sensation of needling. Although it can appear anywhere in the body, the most commonly affected areas are the hands and feet. It can come and go or it can be constant.

People with diabetes are at high risk of developing neuropathy, especially of the feet and legs. This is due to nerve damage caused by years of fluctuating blood sugar levels.

Cryptogenic sensory polyneuropathy is the most common type of neuropathic pain in adults over 50. It is also known as idiopathic sensory polyneuropathy and can be caused by a number of conditions including diabetic neuropathy, some cancers, HIV / AIDS, Parkinson’s, and deficiencies in vitamin B12 , B1 and E, to name a few.

Dealing with Neuropathic Pain

Traditional pain relievers like ibuprofen or paracetamol do not relieve nerve pain, so doctors will have to look elsewhere. They often prescribe medications that people would not associate with pain relief, such as:

  • Antidepressants, including nortriptyline and duloxetine
  • Seizure medications, including gabapentin and pregabalin
  • Topical creams with pain relieving properties such as lidocaine or capsaicin

The study

The University of Kansas study looked at about 400 participants with neuropathic pain. Participants were divided into four groups, each of whom received one of the drugs:

  • Nortriptyline – an antidepressant
  • Duloxetine – another antidepressant
  • Pregabalin – especially for neuropathic pain
  • Mexiletine – used to treat an irregular heartbeat

The study lasted 12 weeks, with ratings at 4, 8, and 12 weeks to determine if there was pain relief. Successful results were when the participants reported a pain reduction of at least 50%.

“This study went beyond whether the drug relieved pain to focus on side effects as well,” lead researcher Richard Barohn, MD, said in a press release. “As the first of its kind, we compared these four drugs in a real-world setting to provide doctors with a body of evidence to support effective management of peripheral neuropathy and the need for new and more effective drugs for neuropathic pain.” Barohn is Executive Vice Chancellor of Health at the University of Missouri.

The results

According to the results of the study, nortriptyline was the most effective of the four drugs, followed by duloxetine. Mexiletene had the highest dropout rate.

Not all drugs were fully effective. M. Vroomen Durning

“There was no clearly superior drug in the study,” said Dr. Barohn. “Of the four drugs, however, nortriptyline and duloxetine performed better when both efficacy and dropouts were taken into account. Therefore, we recommend considering either nortriptyline or duloxetine before the other drugs we tested.”

The take away

People with neuropathic pain sometimes need to try many different treatments, both medical and complementary (like acupuncture), before finding something that will provide relief. If you have neuropathic pain, speak to your doctor and find out which options are right for you.

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