New Guidelines for Treating Neuropathy Pain

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The American Academy of Neurology, in collaboration with the American Association of Neuromuscular and Electrodiagnostic Medicine and the American Academy of Physical Medicine and Rehabilitation, has issued new guidelines on the best treatments for pain from diabetic neuropathy. Neuropathy, or nerve damage, is the most common complication of diabetes.

In people with diabetes, neuropathy is believed to be caused in large part by excess glucose in the blood infiltrating the nerves and interfering with their electrical signals. Sensory neuropathy impacts the nerves responsible for sensation, and typically affects the feet, legs, hands, and arms. Symptoms include pain, numbness, loss of sensation, tingling, coldness, and sensitivity to touch. (Another type of neuropathy, autonomic neuropathy, impacts nerves that control the functions of internal organs, and may cause complications ranging from gastroparesis to sexual dysfunction.)

According to the Academy, strong evidence shows that the anti-seizure drug pregabalin (brand name Lyrica) is effective for the treatment of neuropathy pain. Moderate evidence supports the use of a variety of other treatments, including the antidepressants duloxetine (Cymbalta), venlafaxine (Effexor), and amitriptyline (Elavil, Endep, Vanatrip), the anti-seizure drugs gabapentin (Fanatrex, Gabarone, Neurontin), and valproate (Depacon), and a variety of opioid painkillers. Capsaicin, derived from hot peppers, and transcutaneous nerve stimulation also appear to be effective for treating pain from nerve damage. The guidelines note that doctors should decide which of these treatments to prescribe on a case-by-case basis.

The Academy found that several types of treatment, including reiki therapy, magnetic field therapy, low-intensity laser therapy, and various kinds of medicines, do not appear to be effective treatments for neuropathy pain based on current evidence.

According to lead guidelines author Vera Bril, MD, FRCP, “When neuropathy strikes, it is painful and can disrupt sleep; because of this, it can also lead to mood changes and lower quality of life. It is estimated that diabetic nerve pain affects 16% or more of the more than 25 million people living with diabetes in the United States and is often unreported and more often untreated, with an estimated two out of five cases not receiving care… We were pleased to see that so many of these pain treatments had high-quality studies that support their use.” Bril added that long-term research is still necessary to see how well these treatments are tolerated over time, since neuropathy is a chronic condition.

The guidelines will serve as the basis for new tools that the American Academy of Neurology is developing to help doctors evaluate treatments for people with nerve pain.

For more information about the recommendations, and to see a chart showing all of the recommended treatemtns, read the article “New Guidelines on Best Treatments for Diabetic Nerve Pain” or download the full guidelines from the journal Neurology.

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