Sahagian G. Randomized double-blind study comparing the efficacy of gabapentin with amitriptyline on diabetic peripheral neuropathy

Relevance to family physicians Painful peripheral neuropathy is a common long-term complication of diabetes that affects about 45% of diabetics after 25 years of disease. The pain, which occurs in the hands and lower extremities, ranges from mild to severe and is usually described as a shooting, burning, or tingling sensation in the af fected area. The pain decreases patients’ quality of life and presents an ongoing challenge for family physicians managing the complications of diabetes. Neuropathic pain does not usually respond to traditional analgesics, such as nonsteroidal anti-inflammatory drugs or narcotics, so adjunctive treatment is often required. Several adjunctive treatment options are available, including amitriptyline, imipramine, carbamazepine, antiarrhythmics, and capsaicin cream. Amitriptylines and other tricyclic antidepressants are standard treatment for painful diabetic neuropathy and have shown efficacy in clinical trials. The variability of response and development of intolerable side ef fects, such as sedation, dry mouth, and weight gain, however, can limit use of this medication. Also, amitriptyline is contraindicated for patients receiving monoamine oxidase inhibitors, recovering from myocardial infarction (MI), or suffering acute congestive heart failure. Because of these limitations, alternative treatments with comparable ef ficacy to amitriptyline are needed. Gabapentin has demonstrated efficacy in placebocontrolled trials involving patients with painful DPN. To evaluate its place in treatment relative to standard therapy (amitriptyline), we need comparative data, and this trial provides the first data of that kind.