In the journal JAMA, October 2009, was a description of a patient with diabetes mellitus and much discomfort from neuropathy. The doctor described the case, showed a list of drugs to see the usefulness of these values. Here on this table we see a number of recent rfindings and the relative strength of various painkillers for neuropathic pain. In this paper a clear message: Lyrica and Cymbalta are no better than older and cheaper drugs, which may be even better!

The manufacturers of duloxetine and pregabalin have sought and obtained US Food and Drug Administration (FDA) approval for diabetic polyneuropathy, but their approval should not be interpreted as evidence that that they are superior to other available treatments. Table 2 (zie hieronder) shows that they may be no more effective than many other medications but are considerably more expensive. Two trials that involved 791 patients showed that duloxetine had improved pain more frequently than did placebo (31% more frequently for 60 mg/d and 51% for 120 mg). A pooled analysis of 7 trials showed that pregabalin was more effective than placebo. However, given their higher cost and lack of proven long-term benefit over standard therapies, they generally should not be considered first-line therapy.

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Literatuur op dit gebied zoals door de auteur genoemd:

1. Stamboulis E, Vassilopoulos D, Kalfakis N. Symptomatic focal mononeuropathies in diabetic patients. J Neurol. 2005;252(4):448-452.  2. Dyck PJ, Windebank AJ. Diabetic and nondiabetic lumbosacral radiculoplexus neuropathies. Muscle Nerve. 2002;25(4):477-491. 3. Laughlin RS, Dyck PJ, Melton LJ III, Leibson C, Ransom J, Dyck PJ. Incidence and prevalence of CIDP and the association of diabetes mellitus. Neurology.2009;73(1):39-45. 4. Genuth S, Alberti KG, Bennett P; et al, Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Follow-up report on the diagnosis of diabetes mellitus. Diabetes Care. 2003;26(11):3160-3167.5. Smith AG, Singleton JR. Idiopathic neuropathy, prediabetes and the metabolic syndrome. J Neurol Sci. 2006;242(1-2):9-14.  6. Pirart J. Diabetes mellitus and its degenerative complications: a prospective study of 4,400 patients observed between 1947 and 1973 (3rd and last part) (author's transl) [in French]. Diabete Metab. 1977;3(4):245-256.  7. Pirart J. Diabetes mellitus and its degenerative complications (2nd part) (author's transl) [in French]. Diabete Metab. 1977;3(3):173-182.  8. Pirart J. Diabetes mellitus and its degenerative complications (author's transl) [in French]. Diabete Metab. 1977;3(2):97-107. 9. Tesfaye S, Stevens LK, Stephenson JM; et al. Prevalence of diabetic peripheral neuropathy and its relation to glycaemic control and potential risk factors. Diabetologia.1996;39(11):1377-1384. 10. Dyck PJ, Kratz KM, Karnes JL; et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort.Neurology. 1993;43(4):817-824. 11. Sands ML, Shetterly SM, Franklin GM, Hamman RF. Incidence of distal symmetric (sensory) neuropathy in NIDDM. Diabetes Care. 1997;20(3):322-329.  12. Sumner CJ, Sheth S, Griffin JW, Cornblath DR, Polydefkis M. The spectrum of neuropathy in diabetes and impaired glucose tolerance. Neurology. 2003;60(1):108-111.13. Botez SA, Liu G, Logigian E, Herrmann DN. Is the bedside timed vibration test reliable? Muscle Nerve. 2009;39(2):221-223.  14. Richardson JK. The clinical identification of peripheral neuropathy among older persons. Arch Phys Med Rehabil. 2002;83(11):1553-1558.  15. Kwon OY, Minor SD, Maluf KS, Mueller MJ. Comparison of muscle activity during walking in subjects with and without diabetic neuropathy. Gait Posture. 2003;18(1):105-113. 16. Rutkove SB, Nardin RA, Raynor EM, Levy ML, Landrio MA. Lumbosacral radiculopathy mimicking distal polyneuropathy. J Clin Neuromuscul Dis. 2000;2(2):65-69.  17. Liao KK, Chang MH, Wang S. Distal paresthesia in patients with cervical cord lesions. Zhonghua Yi Xue Za Zhi (Taipei). 1992;50(3):203-207.  18. Oh SJ, Meyer RD. Entrapment neuropathies of the tibial (posterior tibial) nerve. Neurol Clin. 1999;17(3):593-615.  19. Neufeld SK, Cerrato R. Plantar fasciitis: evaluation and treatment. J Am Acad Orthop Surg. 2008;16(6):338-346. 20. Rosenbaum R. Neuromuscular complications of connective tissue diseases. Muscle Nerve. 2001;24(2):154-169.  21. Pirzada NA, Morgenlander JC. Peripheral neuropathy in patients with chronic renal failure. Postgrad Med. 1997;102(4):249-250.  22. Ramchandren S, Lewis RA. Monoclonal gammopathy and neuropathy [published online ahead of print July 21, 2009]. Curr Opin Neurol. doi:10.1097/WCO.0b013e3282ef79e3.  23. Goldman AL, Braman SS. Isoniazid: a review with emphasis on adverse effects. Chest. 1972;62(1):71-77. 24. Quasthoff S, Hartung HP. Chemotherapy-induced peripheral neuropathy. J Neurol. 2002;249(1):9-17.  25. Schaumburg H, Kaplan J, Windebank A; et al. Sensory neuropathy from pyridoxine abuse. N Engl J Med. 1983;309(8):445-448.  26. Law M, Rudnicka AR. Statin safety. Am J Cardiol. 2006;97(8A):52C-60C.  27. Gorson KC, Ropper AH. Additional causes for distal sensory polyneuropathy in diabetic patients. J Neurol Neurosurg Psychiatry. 2006;77(3):354-358. 28. Perkins BA, Bril V. Diabetic neuropathy: a review emphasizing diagnostic methods. Clin Neurophysiol. 2003;114(7):1167-1175.  29. England JD, Gronseth GS, Franklin G; et al, American Academy of Neurology. Evaluation of distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Neurology. 2009;72(2):177-184. 30. Diem P, Laederach-Hofmann K, Navarro X, Mueller B, Kennedy WR, Robertson RP. Diagnosis of diabetic autonomic neuropathy. Eur J Clin Invest. 2003;33(8):693-697. 31. Polydefkis M, Hauer P, Griffin JW, McArthur JC. Skin biopsy as a tool to assess distal small fiber innervation in diabetic neuropathy. Diabetes Technol Ther. 2001;3(1):23-28. 32. Ruth A, Schulmeyer FJ, Roesch M, Woertgen C, Brawanski A. Diagnostic and therapeutic value due to suspected diagnosis, long-term complications, and indication for sural nerve biopsy. Clin Neurol Neurosurg. 2005;107(3):214-217.  33. Figueroa-Romero C, Sadidi M, Feldman EL. Mechanisms of disease: the oxidative stress theory of diabetic neuropathy. Rev Endocr Metab Disord. 2008;9(4):301-314.  34. Pop-Busui R, Sima A, Stevens M. Diabetic neuropathy and oxidative stress. Diabetes Metab Res Rev. 2006;22(4):257-273.  35. Sheetz MJ, King GL. Molecular understanding of hyperglycemia's adverse effects for diabetic complications. JAMA. 2002;288(20):2579-2588.36. Calcutt NA. Potential mechanisms of neuropathic pain in diabetes. Int Rev Neurobiol. 2002;50:205-228.  37. Genuth S. Insights from the Diabetes Control and Complications Trial/Epidemiology of Diabetes Interventions and Complications study on the use of intensive glycemic treatment to reduce the risk of complications of type 1 diabetes. Endocr Pract. 2006;12(suppl 1):34-41.  38. Oates PJ. Aldose reductase, still a compelling target for diabetic neuropathy. Curr Drug Targets. 2008;9(1):14-36.  39. Das Evcimen N, King GL. The role of protein kinase C activation and the vascular complications of diabetes. Pharmacol Res. 2007;55(6):498-510.  40. Boulton AJ, Drury J, Clarke B, Ward JD. Continuous subcutaneous insulin infusion in the management of painful diabetic neuropathy. Diabetes Care. 1982;5(4):386-390.  41. White NH, Waltman SR, Krupin T, Santiago JV. Reversal of neuropathic and gastrointestinal complications related to diabetes mellitus in adolescents with improved metabolic control. J Pediatr. 1981;99(1):41-45.  42. Argoff CE, Backonja MM, Belgrade MJ; et al. Consensus guidelines: treatment planning and options. Diabetic peripheral neuropathic pain. Mayo Clin Proc. 2006;81(4)(suppl):S12-S25.  43. Berger A, Dukes EM, Oster G. Clinical characteristics and economic costs of patients with painful neuropathic disorders. J Pain. 2004;5(3):143-149.  44. Cook RJ, Sackett DL. The number needed to treat: a clinically useful measure of treatment effect. BMJ. 1995;310(6977):452-454. 45. McQuay H, Carroll D, Jadad AR, Wiffen P, Moore A. Anticonvulsant drugs for management of pain: a systematic review. BMJ. 1995;311(7012):1047-1052. 46. Collins SL, Moore RA, McQuay HJ, Wiffen P. Antidepressants and anticonvulsants for diabetic neuropathy and postherpetic neuralgia: a quantitative systematic review. J Pain Symptom Manage. 2000;20(6):449-458.  47. Sindrup SH, Jensen TS. Efficacy of pharmacological treatments of neuropathic pain. Pain. 1999;83(3):389-400.  48. Watson CP, Moulin D, Watt-Watson J, Gordon A, Eisenhoffer J. Controlled-release oxycodone relieves neuropathic pain. Pain. 2003;105(1-2):71-78. 49. Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic polyneuropathy with the antioxidant alpha-lipoic acid. Diabet Med. 2004;21(2):114-121. 50. Tang J, Wingerchuk DM, Crum BA, Rubin DI, Demaerschalk BM. Alpha-lipoic acid may improve symptomatic diabetic polyneuropathy. Neurologist. 2007;13(3):164-167.  51. Harati Y, Gooch C, Swenson M; et al. Double-blind randomized trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998;50(6):1842-1846.52. Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy. Diabetes Care. 2008;31(7):1448-1454.53. Bryans JS, Wustrow DJ. 3-substituted GABA analogs with central nervous system activity. Med Res Rev. 1999;19(2):149-177. 54. Fehrenbacher JC, Taylor CP, Vasko MR. Pregabalin and gabapentin reduce release of substance P and CGRP from rat spinal tissues only after inflammation or activation of protein kinase C. Pain. 2003;105(1-2):133-141. 55. Finnerup NB, Otto M, Jensen TS, Sindrup SH. An evidence-based algorithm for the treatment of neuropathic pain. MedGenMed. 2007;9(2):36.  56. Rowbotham MC, Goli V, Kunz NR, Lei D. Venlafaxine extended release in the treatment of painful diabetic neuropathy. Pain. 2004;110(3):697-706. 57. Kajdasz DK, Iyengar S, Desaiah D; et al. Duloxetine for the management of diabetic peripheral neuropathic pain. Clin Ther. 2007;29(suppl):2536-2546.  58. Hardy T, Sachson R, Shen S, Armbruster M, Boulton AJ. Does treatment with duloxetine for neuropathic pain impact glycemic control? Diabetes Care. 2007;30(1):21-26.59. Mason L, Moore RA, Derry S, Edwards JE, McQuay HJ. Systematic review of topical capsaicin for the treatment of chronic pain. BMJ. 2004;328(7446):991. 60. Goldstein DJ, Lu Y, Detke MJ, Lee TC, Iyengar S. Duloxetine vs placebo in patients with painful diabetic neuropathy. Pain. 2005;116(1-2):109-118. 61. Wernicke JF, Pritchett YL, D'Souza DN; et al. A randomized controlled trial of duloxetine in diabetic peripheral neuropathic pain. Neurology. 2006;67(8):1411-1420. 62. Max MB, Lynch SA, Muir J, Shoaf SE, Smoller B, Dubner R. Effects of desipramine, amitriptyline, and fluoxetine on pain in diabetic neuropathy. N Engl J Med.1992;326(19):1250-1256.  63. Wong MC, Chung JW, Wong TK. Effects of treatments for symptoms of painful diabetic neuropathy. BMJ. 2007;335(7610):87. 64. Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy. Neurology. 2003;60(6):927-934. 65. Backonja M, Beydoun A, Edwards KR; et al. Gabapentin for the symptomatic treatment of painful neuropathy in patients with diabetes mellitus: a randomized controlled trial.JAMA. 1998;280(21):1831-1836. 66. Morello CM, Leckband SG, Stoner CP, Moorhouse DF, Sahagian GA. Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy pain. Arch Intern Med. 1999;159(16):1931-1937. 67. Eisenberg E, Lurie Y, Braker C, Daoud D, Ishay A. Lamotrigine reduces painful diabetic neuropathy: a randomized, controlled study. Neurology. 2001;57(3):505-509.68. Raskin P, Donofrio PD, Rosenthal NR; et al, CAPSS-141 Study Group. Topiramate vs placebo in painful diabetic neuropathy. Neurology. 2004;63(5):865-873. 69. Thienel U, Neto W, Schwabe SK, Vijapurkar U, Topiramate Diabetic Neuropathic Pain Study Group. Topiramate in painful diabetic polyneuropathy. Acta Neurol Scand.2004;110(4):221-231.  70. Ruhnau KJ, Meissner HP, Finn JR; et al. Effects of 3-week oral treatment with the antioxidant thioctic acid (alpha-lipoic acid) in symptomatic diabetic polyneuropathy. Diabet Med. 1999;16(12):1040-1043. 71. Capsaicin Study Group. Effect of treatment with capsaicin on daily activities of patients with painful diabetic neuropathy. Diabetes Care. 1992;15(2):159-165.  72. Barbano RL, Herrmann DN, Hart-Gouleau S, Pennella-Vaughan J, Lodewick PA, Dworkin RH. Effectiveness, tolerability, and impact on quality of life of the 5% lidocaine patch in diabetic polyneuropathy. Arch Neurol. 2004;61(6):914-918. 73. Meier T, Wasner G, Faust M; et al. Efficacy of lidocaine patch 5% in the treatment of focal peripheral neuropathic pain syndromes. Pain. 2003;106(1-2):151-158. 

74. Wilson RC. The use of low-dose trazodone in the treatment of painful diabetic neuropathy. J Am Podiatr Med Assoc. 1999;89(9):468-471. 

75. Sima AA, Calvani M, Mehra M, Amato A, Acetyl-L-Carnitine Study Group. Acetyl-L-carnitine improves pain, nerve regeneration, and vibratory perception in patients with chronic diabetic neuropathy. Diabetes Care. 2005;28(1):89-94. 

76. Yuen KC, Baker NR, Rayman G. Treatment of chronic painful diabetic neuropathy with isosorbide dinitrate spray. Diabetes Care. 2002;25(10):1699-1703. 77. Cohen KL, Harris S. Efficacy and safety of nonsteroidal antiinflammatory drugs in the therapy of diabetic neuropathy. Arch Intern Med. 1987;147(8):1442-1444. 78. Kumar D, Marshall HJ. Diabetic peripheral neuropathy: amelioration of pain with transcutaneous electrostimulation. Diabetes Care. 1997;20(11):1702-1705.  79. Abuaisha BB, Costanzi JB, Boulton AJ. Acupuncture for the treatment of chronic painful peripheral diabetic neuropathy. Diabetes Res Clin Pract. 1998;39(2):115-121.  80. Lavery LA, Murdoch DP, Williams J, Lavery DC. Does anodyne light therapy improve peripheral neuropathy in diabetes? Diabetes Care. 2008;31(2):316-321. 81. Carlsson KC, Hoem NO, Moberg ER, Mathisen LC. Analgesic effect of dextromethorphan in neuropathic pain. Acta Anaesthesiol Scand. 2004;48(3):328-336. 

82. Thisted RA, Klaff L, Schwartz SL; et al. Dextromethorphan and quinidine in adult patients with uncontrolled painful diabetic peripheral neuropathy. Clin Ther. 2006;28(10):1607-1618.

83. Chaudhry V, Russell J, Belzberg A. Decompressive surgery of lower limbs for symmetrical diabetic peripheral neuropathy. Cochrane Database Syst Rev. 2008;(3):CD006152.

84. Benatar M, Chapman KM, Rutkove SB. Repetitive nerve stimulation for the evaluation of peripheral nerve hyperexcitability. J Neurol Sci. 2004;221(1-2):47-52. 85. Miller TM, Layzer RB. Muscle cramps. Muscle Nerve. 2005;32(4):431-442.  86. Diener HC, Dethlefsen U, Dethlefsen-Gruber S, Verbeek P. Effectiveness of quinine in treating muscle cramps. Int J Clin Pract. 2002;56(4):243-246.  87. Tahmoush AJ, Alonso RJ, Tahmoush GP, Heiman-Patterson TD. Cramp-fasciculation syndrome: a treatable hyperexcitable peripheral nerve disorder. Neurology.1991;41(7):1021-1024. 88. Rutkove SB, Matheson JK, Logigian EL. Restless legs syndrome in patients with polyneuropathy. Muscle Nerve. 1996;19(5):670-672.  89. Gemignani F, Brindani F, Vitetta F, Marbini A, Calzetti S. Restless legs syndrome in diabetic neuropathy. J Peripher Nerv Syst. 2007;12(1):50-53.  90. Ferini-Strambi L. Treatment options for restless legs syndrome. Expert Opin Pharmacother. 2009;10(4):545-554.  91. Gaede P, Vedel P, Larsen N, Jensen GV, Parving HH, Pedersen O. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med.2003;348(5):383-393. 92. Boulton AJ, Vinik AI, Arezzo JC; et al, American Diabetes Association. Diabetic neuropathies: a statement by the American Diabetes Association. Diabetes Care. 2005;28(4):956-962. 93. Hersh EV, Pinto A, Moore PA. Adverse drug interactions involving common prescription and over-the-counter analgesic agents. Clin Ther. 2007;29(suppl):2477-2497. 94. Zimmermann M. Pathobiology of neuropathic pain. Eur J Pharmacol. 2001;429(1-3):23-37.  95. Girach A, Manner D, Porta M. Diabetic microvascular complications: can patients at risk be identified? Int J Clin Pract. 2006;60(11):1471-1483.

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