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In a systematic review of over 100 clinical studies published in the journal Neurology, AHRQ researchers found moderate evidence that the SNRI antidepressants duloxetine (Cymbalta) and venlaxine (Effexor) were effective in reducing neuropathic pain. Nausea, dizziness and somnolence were common side effects of the drugs.
The evidence was weaker for anti-seizure medication such as pregabalin (Lyrica) and oxcarbazepine (Trileptal). Common side effects from those drugs are weight gain, dizziness, headache and nausea.
While pregabalin works in the same way as gabapentin (Neurontin) -- both are often used to treat nerve pain -- the reviewers found gabapentin was not more effective than placebo. The seizure drug valproate and capsaicin cream were also found to be ineffective.
Oxycodone was not effective in treating neuropathy pain, and the evidence was weak for two other opioids, tramadol and tapentadol.
The U.S. Food and Drug Administration has approved only three medications -- duloxetine, pregabalin and tapentadol -- for diabetic nerve pain. However, many others drugs are prescribed “off label” for the disease.
"We hope our findings are helpful to doctors and people with diabetes who are searching for the most effective way to control pain from neuropathy," said Waldfogel. "Unfortunately, there was not enough evidence available to determine if these treatments had an impact on quality of life.”
Researchers noted that all of the studies were short-term, many for less than three months, and even the most effective drugs had relatively high rates of side effects. They say longer-term studies are needed so that adverse effects and the continued effectiveness of the drugs can be assessed.
There's the link:
Cochrane is a global independent network of researchers, professionals, patients, carers and people interested in health
Cochrane Database of Systematic Reviews was conducted to further examine dosing regimens for neuropathic pain. In a review analyzing 37 studies for gabapentin treatment in chronic neuropathic pain. Gabapentin at doses of 1800 mg to 3600 mg daily (1200 mg to 3600 mg gabapentin encarbil) can provide good levels of pain relief to some people with postherpetic neuralgia and peripheral diabetic neuropathy. Evidence for other types of neuropathic pain is very limited. The outcome of at least 50% pain intensity reduction is regarded as a useful outcome of treatment by patients, and the achievement of this degree of pain relief is associated with important beneficial effects on sleep interference, fatigue, and depression, as well as quality of life, function, and work. Around 3 or 4 out of 10 participants achieved this degree of pain relief with gabapentin, compared with 1 or 2 out of 10 for placebo. Over half of those treated with gabapentin will not have worthwhile pain relief but may experience adverse events. Conclusions have not changed since the previous update of this review.
Patient 1: I used gabapentin for about 5 years. I had to stop because I maxed out on the dosage. It is a drug that you have to increase dose over time.
Patient 2: A while back I took Gabapentin for a few years, then discontinued it which was no fun (you need to withdraw very slowly). When I started having twitching & cramping, I agreed to go back on, and it controlled those symptoms well. I don't really know if it's currently doing anything for me as far as the nerve pain. Side effects for me are sedation (which may be a good thing for you if your having trouble sleeping), memory problems (particularly searching for a word or name you want to say but can't remember it), weight gain, and some loss of libido.
In clinical studies it was shown that for some patients:
LYRICA helped relieve moderate to even severe diabetic nerve pain
• Even if you've had diabetic nerve pain for several years, LYRICA may be able to help. For some patients, LYRICA can provide significant relief from diabetic nerve pain. In a 5‑week clinical study, some patients taking LYRICA felt significant pain relief and felt better than those patients taking a sugar pill known as a placebo
• Even if you've had diabetic nerve pain for several years, LYRICA may be able to help. For some patients, LYRICA can provide significant relief from diabetic nerve pain. In a 5‑week clinical study, some patients taking LYRICA felt significant pain relief and felt better than those patients taking a sugar pill known as a placebo.
• LYRICA is believed to work on damaged nerves, or calm overactive nerves, depending on your condition. It is unknown exactly how LYRICA works in the body. However, certain studies suggest that LYRICA reduces “extra” electrical signals sent out by damaged nerves in the body. The implication of these studies in humans is not known.