Loading...
For patients with diabetic peripheral neuropathy pain, most guidelines recommend initial treatment with amitriptyline, duloxetine, pregabalin, or gabapentin; however, monotherapy with any of these agents often provides incomplete relief, and head-to-head comparisons are rare. Clinicians sometimes add a second agent when monotherapy fails for their patients, but this strategy has not been assessed in high-quality studies.
Researchers defined three 16-week pragmatic treatment pathways, with each starting agent titrated to maximal tolerated dose over 6 weeks then supplemented (if the first agent provided suboptimal relief) by a second agent for the final 10 weeks. The pathways were (1) amitriptyline supplemented by pregabalin, (2) duloxetine su…