PAIN+ CPN

Doctor, I have diabetic peripheral neuropathic pain. Will duloxetine or pregabalin help me to manage it?


Either duloxetine or pregabalin might be an option to help you manage your pain. Both drugs have some side effects. You can discuss with your doctor to help you choose a medication that is right for you.

What is the evidence?


Researchers looked at patients receiving duloxetine and compared them to patients receiving pregabalin in Japan. They measured pain, quality of life, and side effects. They found that:

  • At 12 weeks, patients in the duloxetine group had similar amounts of pain relief to patients in the pregabalin group
  • Patients in both groups experienced a meaningful reduction in pain
  • Quality of life was similar in both groups
  • Slightly more patients experienced side effects with pregabalin (36%) than with duloxetine (30%)


What kind of study was this?


This was a randomized controlled trial (RCT). In an RCT, patients are randomly assigned to receive the treatment under study or a comparator treatment.

Who participated in the study? This study included 303 people in Japan with pain due to polyneuropathy caused by type 1 or type 2 diabetes. These people had never been treated with either duloxetine or pregabalin.

How was the study done? The study compared treatment with duloxetine to pregabalin. Patients received duloxetine or pregabalin for 12 weeks, tapered off the drug for 1 week, and then a 1 week follow up.


Duloxetine

vs

Pregabalin

Duloxetine was administered at 20 mg/day for one week, then 40 mg/day for 3 weeks. At weeks 4 and/or 8, the drug dose could be increased for patients who had not experienced significant pain relief.


Pregabalin was administered at 150 mg/d for one week, then 300 mg/day for 3 weeks. At weeks 4 and/or 8, the drug dose could be increased for patients who had not experienced significant pain relief.

Why was this research done?


Diabetic peripheral neuropathy can occur in up to 50% of patients with diabetes, and causes substantial morbidity, mortality, and reduces quality of life. One of the most frequent complications of diabetes is neuropathic pain.

Pregabalin and duloxetine are both recommended as first-line treatments for moderate to severe painful neuropathy in Japanese guidelines and in international treatment guidelines.

Direct comparisons between drugs can help to establish the relative effectiveness and the different side effect profiles of the drugs. The authors wanted to establish whether duloxetine and pregabalin provided similar levels of pain relief for patients with painful diabetic neuropathy.


This Evidence Summary is based on the following article:

Enomoto H, Yasuda H, Nishiyori A, et al. Duloxetine in patients with diabetic peripheral neuropathic pain in Japan: a randomized, doubleblind, noninferiority comparative study with pregabalin. J Pain Res. 2018 Sep 13;11:1857-1868. doi: 10.2147/JPR.S170646. eCollection 2018. PubMed

Published: Tuesday, June 11, 2019