Efficacy and tolerability of carbamazepine for the treatment of painful diabetic neuropathy in adults: a 12-week, open-label, multicenter study

Abstract

ObjectiveAnticonvulsants are increasingly being used in the symptomatic management of several neuropathic pain disorders. The present observational study was designed to evaluate the efficacy, tolerability, and quality of life (QoL) of carbamazepine use for 12 weeks in patients with painful diabetic neuropathy, in Pakistan.MethodsThis was a 12-week, multicenter, open-label, uncontrolled trial in adult type 2 diabetic patients (aged 18–65 years) suffering from clinically confirmed neuropathic pain (Douleur Neuropathique en 4 [DN4] score ≥4). Change in neuropathic pain at week 12 compared with baseline was assessed using the Brief Pain Inventory Scale–Short Form (pain severity score and pain interference score). QoL was determined by the American Chronic Pain Association QoL scale. Safety was assessed based on patient reported adverse events (AEs) and serious AEs.ResultsOf the total 500 screened patients, 452 enrolled and completed the study. The mean (± standard deviation [SD]) pain interference score decreased from 4.5±2.0 at baseline to 3.1±1.9 at week 12 (P<0.001). The mean (± SD) pain severity score decreased from 5.8±2.0 at baseline to 3.6±2.2 at week 12 (P<0.001). There was a decrease of ≥30% in the pain severity score between visits. The mean (± SD) QoL scale score improved from 5.9±1.6 at baseline to 8.0±1.7 at week 12. A total of ten (2.2%) patients reported AEs during the study period. No patient discontinued the study due to AEs.ConclusionIn this real-life experience study, carbamazepine, when prescribed for 12 weeks to adult diabetic patients suffering from neuropathic pain, showed pain-relief effect, with reduced mean pain severity and mean pain interference scores and with improved QoL and good tolerability profile.

The Efficacy of Adding Electromagnetic Therapy or Laser Therapy to Medications in Patients With Diabetic Peripheral Neuropathy

“…It means that proper medical treatment alone or in addition to magnetic or laser interventions can achieve satisfactory analgesic effects for patients with DPN. 4,11,27 Thus analgesic medications are still the most commonly used option to manage DPN. These drugs can achieve the analgesic effects for neuropathic pain with wide variability depending upon the used drugs and the extent of underlying neuropathic pathology changes.…”

“…These drugs can achieve the analgesic effects for neuropathic pain with wide variability depending upon the used drugs and the extent of underlying neuropathic pathology changes. 11,23 In addition, in the long run, the required analgesic doses of those patients who will be exposed to magnetic or laser therapy will be less because of extra positive changes in underlying neuropathic pathology. The TRCNSS reduced significantly after adding either magnetic or laser therapy to drug therapy, but non-significant reductions were obtained in those patients who received only drug therapy.…”

“…10 The administration of analgesics as tricyclic anti-depressants and topical agents may be effective but with limited success and unsatisfactory results. 11 However, around half of the patients with DPN have shown adequate symptomatic pain relief in association with frequent side effects such as drowsiness, lethargy and unsteadiness. 11 In addition, these analgesics do not stop or delay the progression of the underlying pathological neuropathic changes.…”

“…11 However, around half of the patients with DPN have shown adequate symptomatic pain relief in association with frequent side effects such as drowsiness, lethargy and unsteadiness. 11 In addition, these analgesics do not stop or delay the progression of the underlying pathological neuropathic changes. 12 Physical therapy can actively relieve the signs and symptoms of DPN.…”

Neuropathic Corneal Pain

“…The recommendations were based on the pooled results of four placebo-controlled studies including a total of 147 patients, treated with 300–2400/day. 124 In 4 RCTs in TNG, comparing CBZ to placebo, superiority of CBZ was demonstrated, with 70% of CBZ-treated patients showing partial or complete pain relief 125 . The most common side effects include drowsiness, headache, and dizziness 125 .…”