Korean J Pain.  2018 Oct;31(4):253-260. 10.3344/kjp.2018.31.4.253.

Therapeutic alternatives in painful diabetic neuropathy: a meta-analysis of randomized controlled trials

• Vilar S
• Castillo J
• Munuera Martínez PV
• Reina M
• Pabón M

• KMID: 2421516
• DOI: http://doi.org/10.3344/kjp.2018.31.4.253

Abstract

BACKGROUND
One of the most frequent problems caused by diabetes is the so called painful diabetic neuropathy. This condition can be treated through numerous types of therapy. The purpose of this study was to analyze, as a meta-analysis, different treatments used to alleviate painful diabetic neuropathy, with the aim of generating results that help making decisions when applying such treatments to tackle this pathology.
METHODS
A search was conducted in the main databases for Health Sciences, such as PUBMED, Web of Science (WOS), and IME biomedicina (Spanish Medical Reports in Biomedicine), to gather randomized controlled trials about treatments used for painful diabetic neuropathy. The analyzed studies were required to meet the inclusion criteria selected, especially those results related to pain intensity.
RESULTS
Nine randomized controlled trials were chosen. The meta-analysis shows significant positive effects for those treatments based on tapentadol [g: −1.333, 95% CI (−1.594; −1.072), P < 0.05], duloxetine [g: −1.622, 95 % CI (−1.650; −1.594), P < 0.05], pregabalin [g: −0.607, 95% CI (−0.980; −0.325), P < 0.05], and clonidine [g: −0.242, 95 % CI (−0.543; −0.058), P < 0.05].
CONCLUSIONS
This meta-analysis indicates the effectiveness of the treatments based on duloxetine, gabapentin and pregabalin, as well as other drugs, such as tapentadol and topic clonidine, whose use is better prescribed in more specific situations. The results provided can help increase the knowledge about the treatment of painful diabetic neuropathy and also in the making of clinical practice guidelines for healthcare professionals.

Keyword

Chronic pain; Diabetes complications; Diabetic neuropathies; Pain; Pain management; Pain unit

MeSH Terms

Chronic Pain
Clonidine
Delivery of Health Care
Diabetes Complications
Diabetic Neuropathies*
Duloxetine Hydrochloride
Pain Management
Pathology
Pregabalin
Clonidine
Duloxetine Hydrochloride
Pregabalin

Figure

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  Fig. 1 Flow diagram of the included studies.

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  Fig. 2 Risk of bias summary.

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  Fig. 3 Risk of bias graph.

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  Fig. 4 Forest plot of meta-analytic results.

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