Peripheral neuropathy — a potential complication of diabetes that can cause numbness, tingling and pain in your legs or arms — can be one of the most debilitating consequences of diabetes in some people. While many long-term complications of diabetes can interfere with your quality of life, pain has an immediate, visceral effect that can make both patients and doctors willing to take risks to control it — including by prescribing opioid medications for pain.
Clinical guidelines for treating diabetic peripheral neuropathy don’t recommend using opioid pain medications, due to concerns about their safety and a lack of data demonstrating their efficacy. Instead, guidelines recommend using a range of options including topical pain relievers, anticonvulsant drugs and antidepressants to help relieve this form of pain. But as a new analysis shows, the lack of support in guidelines for using opioids to treat neuropathy hasn’t stopped many doctors from prescribing them at concerning levels.
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Opioid use down, but prescriptions still common
The analysis, published in the journal JAMA Network Open, looked at the electronic health records of 3,496 people in the Mayo Clinic health system from 2014 to 2018. Researchers wanted to know what drugs were prescribed in the first 12 months after a diagnosis of diabetic peripheral neuropathy. Only drugs that hadn’t been prescribed in the previous 12 months for nonopioids, or three months for opioids, were included in the analysis.
The researchers grouped all prescriptions into three categories — drugs that fit with clinical guidelines; “acceptable” treatments that aren’t discouraged by guidelines; and opioids, which aren’t recommended.
In a somewhat encouraging trend, the proportion of people with newly diagnosed neuropathy who received opioid prescriptions declined from 45.6% to 35.2% between 2014 and 2018. But the fact that 43.8% of all new prescriptions to treat pain from neuropathy during the study period were for opioids is still very concerning. As noted in a MedPage Today article on the study, the American Diabetes Association’s 2020 Standards of Medical Care in Diabetes state that “the use of any opioids for management of chronic neuropathic pain carries the risk of addiction and should be avoided.”
A similar proportion of new prescriptions to treat pain from neuropathy, 42.9%, were for recommended drugs like Lyrica (generic name pregabalin), gabapentin or serotonin-norepinephrine reuptake inhibitors — a group that includes Effexor XR (venlafaxine), Cymbalta (duloxetine), Savella (milnacipran) and Pristiq (desvenlafaxine).
The odds of receiving any prescription for pain from neuropathy were higher if people had depression, arthritis or back pain in addition to their neuropathy. People who received opioid prescriptions were more likely to be male, and less likely to have a diagnosis of fibromyalgia.
Getting safe, effective neuropathy treatment
The researchers noted that the high rate of opioid prescriptions remains concerning “because safer effective treatment options are available,” including topical treatments developed specifically to treat peripheral neuropathy. It’s unclear why so many doctors or patients weren’t willing to try these treatments, which tend to have a low risk of serious side effects and an excellent overall safety profile.
Limitations to the analysis include the fact that the duration of prescription use wasn’t included, meaning that some opioid prescriptions may have been for shorter-term use. The analysis was also limited to three locations affiliated with a single healthcare provider. More research is needed, the researchers wrote, to learn about nationwide trends in opioid prescriptions for diabetic peripheral neuropathy, and what factors lead doctors to prescribe these drugs despite clinical recommendations that discourage them.
If you have peripheral neuropathy and are concerned about the safety or efficacy of your treatment, ask your doctor about the other treatment options available — or, if you have concerns about your doctor’s treatment strategy, seek a second opinion from another doctor with experience treating neuropathy.