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Treatment of diabetic neuropathy, one of the most common sources of neuropathic pain, has traditionally involved tricyclic antidepressants. Recently, gabapentin has become popular due to perceived safety advantages and more rapid onset of relief. No previous study has compared the two classes of agents for efficacy or side effects. In this prospective, double-blind, double-dummy, cross-over trial, 25 patients were randomized to amitriptyline or gabapentin in two six-week treatment periods with a one-week washout before cross-over. Doses were capped at 1800 mg (gabapentin) and 75 mg (amitriptyline). Outcome measures included pain, pain relief, and global assessments. The pain scale was valid but somewhat nonintuitive.
Sixty-five percent of pa…