A systematic review and comparative effectiveness network meta-analysis «Griebeler ML, Morey-Vargas OL, Brito JP et al. Pha...»3 assessing 27 pharmacologic interventions included 65 randomized, controlled trials involving 12 632 patients with painful diabetic neuropathy. Half of these studies had high or unclear risk of bias. 9 head-to-head trials showed greater pain reduction associated with serotonin-norepinephrine reuptake inhibitors (SNRIs) than anticonvulsants (standardized mean difference [SMD] -0.34, 95% credible interval [CrI], -0.63 to -0.05) and with tricyclic antidepressants (TCAs) than topical capsaicin 0.075%. Network meta-analysis showed that SNRIs (SMD -1.36, CrI -1.77 to -0.95), topical capsaicin (SMD -0.91, CrI, -1.18 to -0.08), TCAs (SMD -0.78,CrI, -1.24 to -0.33), and anticonvulsants (SMD -0.67, CrI -0.97 to -0.37) were better than placebo for short-term pain control. Specifically, carbamazepine (SMD -1.57, CrI -2.83 to -0.31), venlafaxine (SMD -1.53, CrI -2.41 to -0.65), duloxetine (SMD -1.33, CrI -1.82 to -0.86), and amitriptyline (SMD -0.72, CrI -1.35 to -0.08) were more effective than placebo. Adverse effects included somnolence and dizziness with TCAs, SNRIs, and anticonvulsants; xerostomia with TCAs; and peripheral edema and burning sensation with pregabalin and capsaicin.
A systematic review and Bayesian network meta-analysis «...»4 included 43 trials with 7877patients. Statistically significant treatment difference for 50% pain reduction was reported for duloxetine vs. placebo (OR 2.50; CrI 1.62 to 3.91), mirogabalin vs. placebo (OR 3.25; CrI 1.16 to 9.35), pregabalin vs. placebo (OR 2.33; CrI 1.69 to 3.27), duloxetine vs. carbamazepine (OR 3.37; CrI 1.07 to 10.90), and pregabalin vs. nortriptyline (OR 4.10, CrI 1.13 to 5.28). Nortriptyline reported the highest possibility of achieving 30% and 50% pain reduction.
A systematic review and network meta-analysis «...»5 included 3 trials with 290 patients. No significant differences were observed between patients receiving duloxetine and gabapentin with respect to VAS (mean change difference -1.23, 95% CI -6.09 to 3.62; P = .62), Diabetic Neuropathy Symptom (DNS) score (mean change difference 0.14, 95% CI -0.35 to 0.63; P = .58), and Neuropathic Disability Score (NDS) (mean change difference 0.30, 95% CI -0.02 to 0.63; P = .07).
A Cochrane review «Antidepressants for neuropathic pain»1 «Saarto T, Wiffen PJ. Antidepressants for neuropath...»1 included 61 studies with a total of 3293 subjects. Tricyclic antidepressants including amitriptyline, imipramine and desipramine had an NNT of 3.1 (95% CI 2.5 to 4.2) for the achievement of at least moderate pain relief. Venlafaxine (3 studies) has an NNT of 3.1 (95% CI 2.2 to 5.1) RR 2.2 (95% CI 1.5 to 3.1) with global improvement or pain relief measurements. For diabetic neuropathy the NNT for effectiveness of TCA was 1.3 (95% CI 1.2–1.5), RR 12.4 (95% CI 5.2–29.2; 5 studies); for postherpetic neuralgia 2.7 (95% CI 2 to 4.1), RR 2.2 (95% CI 1.6 to 3.1; 4 studies).
A Cochrane review «Antidepressants for pain management in adults with chronic pain: a network meta‐analysis»2 «» «...»2 included 176 studies with a total of 28664 subjects. The most common pain conditions examined were fibromyalgia (59 studies); neuropathic pain (49 studies) and musculoskeletal pain (40 studies). Duloxetine standard dose (60 mg) showed a small to moderate effect for substantial pain relief (OR 1.91, 95% CI 1.69 to 2.17; 16 studies, n=4490) and continuous pain intensity (standardised mean difference (SMD) −0.31, 95% CI −0.39 to −0.24; 18 studies, n=4959). For pain intensity, milnacipran standard dose (100 mg) also showed a small effect (SMD −0.22, 95% CI −0.39 to 0.06; 4 studies, n=1866).