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Pregabalin May Benefit Diabetic Nerve Pain


The American Academy of Neurology has issued new guidelines on the most effective treatments for diabetic nerve pain and has found that a seizure drug can treat the neuropathy and improve quality of life for patients with diabetes. The guideline was presented at the American Academy of Neurology’s Annual Meeting in Honolulu.

Diabetic Neuropathy Is Undertreated in the United States

Pregabalin, brand name Lyrica, is an oral medication used for treating pain caused by neurologic diseases as well as seizures. It is also used for treating fibromyalgia. It is believed to work by binding to calcium channels on nerves and possibly modifying the release of neurotransmitters. The US Food and Drug Administration approved pregabalin in December 2004.

Diabetic nerve pain, tingling or burning pain in the hands and feet caused by nerve damage from hyperglycemia, is estimated to affect 16% of the more than 25 million people in the United States living with diabetes. It is believed that about two out of five cases go unreported and untreated.

Read: Treating Painful Diabetic Peripheral Neuropathy

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The recommended initial dose of pregabalin for neuropathic pain is 50 milligrams, three times a day. The dose may be increased to a maximum of 100 mg three times daily after one week. The most common side effects are dizziness, drowsiness, dry mouth, edema, blurred vision, weight gain and difficulty concentrating.

While the evidence is strong that pregabalin is effective in treating diabetic neuropathy, doctors should determine if it is appropriate for their patients on a case-by-case basis. Certain medications can interact with Lyrica, requiring careful monitoring by a physician.

Read: TENS Not Effective for Back Pain but Good for Diabetics

The American Academy of Neurology guidelines note that other seizure treatments such as gabapentin and valproate, antidepressants such as venlafaxine or duloxetine, and painkillers are probably also effective. Transcutaneous electric nerve stimulation (TENS) should also be considered as an option for treating diabetic nerve pain.

“We were pleased to see that so many of these pain treatments had high-quality studies that support their use,” said lead guideline author Vera Bril MD FRCP of the University of Toronto. “Still, it is important that more research be done to show how well these treatments can be tolerated over time since diabetic nerve pain is a chronic condition that affects a person’s quality of life and ability to function.”

The AAN guidelines will be released in 2012 and will appear in the April issue of the journal Muscle and Nerve from the American Association of Neuromuscular and Electrodiagnostic Medicine as well as the April issue of PM&R, the journal of the American Academy of Physical Medicine and Rehabilitation.