Abstract
Background Diabetic peripheral neuropathic pain (DPNP) is a common chronic pain condition affecting diabetic patients and has growing importance because of the increasing prevalence of patients with type 2 diabetes mellitus. Pain is the most troublesome symptom of DPNP, increasingly recognized as an important and independent feature of DPNP. This meta-analysis aims to compare the efficacy and safety of duloxetine and gabapentin in the treatment of diabetic peripheral neuropathic pain (DPNP) and therefore to provide evidence-based medicine for clinical treatment. Methods Relevant randomized controlled trials on duloxetine versus gabapentin for DPNP were searched from PubMed, Embase, Cochrane Library, Web of Science, CNKI, WanFang, VIP, and Chinese Biomedical Literature Database from database inception to October 2021. The data were analyzed by RevMan 5.3 software. Results Seven studies were included. The results showed that, at the end of the study, duloxetine was significantly superior to gabapentin in terms of the incidence of adverse reactions (RR = 0.59, 95% CI: 0.45–0.79, P < 0.01), sleep interference score (SMD = −0.35, 95% CI: −0.63 to −0.08, P < 0.05), but no significant differences in VAS score (SMD = −0.14, 95% CI: −0.31–0.03, P > 0.05), overall response rate (RR = 1.05, 95% CI: 0.92–1.20, P > 0.05), and clinical global impression of change (SMD = 0.07, 95% CI: −0.20–0.35, P > 0.05). Conclusion Compared with gabapentin, duloxetine has no obvious advantage in the treatment of diabetic peripheral neuralgia, but it has less side effects and significantly higher safety.
Highlights
Diabetic peripheral neuropathic pain (DPNP), with an incidence up to 26% in all diabetic patients, is one of the most common, complex, and serious complications of diabetes [1]. is disease is mainly characterized by symmetrical numbness, paresthesia, and pain in the distal extremities, with symptoms ranging from mild sensory disturbances to severe persistent pain [2]
In addition to glycemic control, the therapeutic base for all diabetic complications, antidepressant or anticonvulsant drugs are recommended for DPNP
Duloxetine, originally approved for the treatment of major depression, is a selective serotonin (5-HT) and norepinephrine (NE) reuptake inhibitor (SNRI) [3]. is drug is the first SNRI for DPNP approved by the U.S Food and Drug Administration (FDA) in September 2004 [4]. 5HT and NE are two main neurotransmitters involving in the descending mechanism of pain; 5-HT can inhibit pain perception and facilitate pain perception; NE released by peripheral sympathetic postganglionic fibers is Contrast Media & Molecular Imaging involved in the generation of pain
Summary
Diabetic peripheral neuropathic pain (DPNP), with an incidence up to 26% in all diabetic patients, is one of the most common, complex, and serious complications of diabetes [1]. is disease is mainly characterized by symmetrical numbness, paresthesia, and pain in the distal extremities, with symptoms ranging from mild sensory disturbances to severe persistent pain [2]. Diabetic peripheral neuropathic pain (DPNP), with an incidence up to 26% in all diabetic patients, is one of the most common, complex, and serious complications of diabetes [1]. As a synthetic amino acid, the mechanism of its effect against allodynia includes increasing the input of inhibitors of the gamma-aminobutyric acid (GABA) mediated pathway, antagonizing N-methyl-D-aspartate (NMDA) receptors, antagonizing calcium channels in the central nervous system, and inhibiting the conduction of peripheral nerves, which is a better clinical drug for neuropathic pain [6]. Is meta-analysis aims to compare the efficacy and safety of duloxetine and gabapentin in the treatment of diabetic peripheral neuropathic pain (DPNP) and to provide evidence-based medicine for clinical treatment. Duloxetine has no obvious advantage in the treatment of diabetic peripheral neuralgia, but it has less side effects and significantly higher safety
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