More than 20 million people in the U.S. suffer neuropathic pain. At least 25% of those cases are classified as unexplained and considered cryptogenic sensory polyneuropathy (CSPN). There is no information to guide a physician’s drug choices to treat CSPN, but a researcher from the University of Missouri School of Medicine and MU Health Care led a first-of-its-kind prospective comparative effectiveness study.

“This study went beyond whether the drug reduced pain to also focus on adverse effects,” said Richard Barohn, MD, lead researcher and executive vice chancellor for health affairs at the University of Missouri. “As the first study of its kind, we compared these four drugs in a real-life setting to provide physicians with a body of evidence to support the effective management of peripheral neuropathy and to support the need for newer and more effective drugs for neuropathic pain.”

“There was no clearly superior performing drug in the study,” Barohn said. “However, of the four medications, nortriptyline and duloxetine performed better when efficacy and dropouts were both considered. Therefore, we recommend that either nortriptyline or duloxetine be considered before the other medications we tested.”