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A new systematic review and network meta-analysis of drug therapies for painful diabetic neuropathy has been published. The reviewers discovered 65 relevant randomized trials involving 27 medications, with nearly 13,000 participants. Key findings are as follows:
Serotonin-norepinephrine reuptake inhibitors (SNRIs), topical capsaicin, tricyclic antidepressants (TCAs), and anticonvulsants all reduced pain compared with placebo.
As a group, SNRIs and TCAs reduced pain more than did anticonvulsants and capsaicin.
Very few studies extended beyond 3 months' duration.
For individual drugs, carbamazepine, venlafaxine, duloxetine, amitriptyline, and pregabalin1 were statistically superior to placebo.
Few head-to-head comparisons of individual drugs exist…