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Most peripheral neuropathies are caused by diabetes or alcohol misuse, but the next most common type is idiopathic. Various drugs are used to treat patients with painful idiopathic neuropathy, but their relative efficacy is unclear. In this open-label trial, investigators randomized 402 adults with painful chronic idiopathic sensory polyneuropathy to receive nortriptyline, duloxetine, pregabalin, or mexiletine (mexiletine is an antiarrhythmic drug that is sometimes prescribed off-label to manage neuropathic pain). Drugs were titrated over 4 weeks to the following maximal daily doses, if tolerated: nortriptyline (75 mg), duloxetine (60 mg), pregabalin (300 mg), mexiletine (600 mg).
At 12 weeks, percentages of patients who achieved ≥50% reduct…