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Consider Cost When Choosing Diabetic Neuropathy Treatment

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If you have diabetes, there’s a 50 percent chance you also have diabetic neuropathy—permanent nerve damage that often affects the feet and legs, causing numbness, burning, sensitivity to touch and sharp, stabbing pain. You may also have turned to topical or oral medications to help relieve your pain and discomfort.

But when you reach for a pain reliever, how do you know whether another drug might do a similar or better job of relieving pain, perhaps for less cost?

Sorting out medical therapies

Mayo Clinic researchers recently set out to compare the effectiveness of drug therapies to relieve diabetic neuropathy pain. After reviewing 65 studies of nearly 27 drug treatments and 13,000 individuals, they couldn’t designate a clear winner among the drugs, especially for long-term relief, because of insufficient evidence. Reporting last November in Annals of Internal Medicine, the researchers agreed that more long-term, head-to-head drug comparisons are needed. In an accompanying commentary, two University of Michigan experts suggested that, with the limited evidence available, cost may be a deciding factor for doctors when choosing a drug to prescribe for easing neuropathy.

Drugs used to treat diabetic neuropathy fall into several categories:

¦ Antidepressants, including tricyclics and serotonin–norepinephrine reuptake inhibitors (SNRIs)

¦ Antiseizure drugs, or anticonvulsants

¦ Topical capsaicin, an over-the-counter pain reliever (available as Capsin and other brands)

¦ Opioids (dextromethorphan, morphine sulfate, tramadol, oxycodone)

The SNRI duloxetine (Cymbalta), the anticonvulsant pregabalin (Lyrica) and the opioid tapentadol (Nucynta) are the only drugs approved by the Food and Drug Administration to treat diabetic neuropathic pain. But doctors regularly use other drugs “off label” because they’re effective in treating chronic pain conditions, including diabetic neuropathy.

Cost and other considerations

The University of Michigan experts suggest that the most important factors to consider are coexisting medical conditions, side effects and cost. Anticonvulsants may be the best option for people who have both epilepsy and neuropathy, say the experts. Similarly, antidepressants may be a smart choice for neuropathy sufferers who are also depressed. Fortunately, the risk of adverse effects for most people is likely to be low at the doses typically used for neuropathic pain.

Costs vary widely among drugs. According to the commentary, retail cost for pregabalin, at about $190 a month, is close to 10 times that of the least-expensive option. Drugs like amitriptyline (a tricyclic antidepressant) and gabapentin (an anticonvulsant) are significantly less expensive, hovering around $13 to $19 a month. Capsaicin is a low-cost, over-the-counter alternative, at about $14 a month.

The most cost-effective approach, say the experts, is to start with a tricyclic antidepressant, followed by gabapentin, reserving higher-cost options for cases in which less costly treatments have failed. This approach supports the ADA’s recommendations.


Posted in Diabetes on October 15, 2015

Medical Disclaimer: This information is not intended to substitute for the advice of a physician. Click here for additional information: Health After 50 Disclaimer

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