The past year in neuropathic pain: evidence supporting pregabalin and duloxetine, new therapies, devices and other key studies, each summarised in the MedShorts 360 format with its date and source.
NeurologyIn 814 ICU survivors, 47.7% reported significant pain three months later, and 8.7% of these screened positive for neuropathic pain; experts set out a primary-care approach.
NeurologyIn 67 patients, bupropion lowered average daily pain by 0.5 points more than placebo, with an NNT of 15 for 50% relief.
NeurologyEleven endocrinologists agreed 61 statements on neuropathy screening and treatment for an Asian setting, naming pregabalin, gabapentin, duloxetine and TCAs and discouraging routine opioids.
NeurologyIn a patient with oxaliplatin neuropathy, pain fell from 9/10 to 4/10 over three weeks on suzetrigine, allowing cuts in gabapentin and oxycodone.
NeurologyAcross six RCTs and 324 patients, taVNS reduced pain at one and four weeks and doubled the clinical response rate, though benefit faded by 12 weeks.
NeurologyAdding two 10-minute VR sessions a day for five days to standard care lowered pain scores and improved mood and self-efficacy in 50 inpatients.
NeurologyA new systematic review found significant pooled pain reductions with duloxetine, gabapentin and pregabalin, with only modest differences between first-line agents.
NeurologyIn a 20-patient sham-controlled pilot, intermittent theta-burst stimulation of the motor cortex lowered neuropathic pain scores with no adverse effects.
NeurologyIn 93 patients with an inadequate response to pregabalin, switching to crisugabalin 40 mg/day reduced SF-MPQ pain by a further 7.2 points over four weeks, with fewer adverse events.
NeurologyPatients with N-desmethyl-clobazam levels above 1,000 ng/mL were far more likely to achieve 30% pain relief (83.3% vs 38.5% on placebo).
NeurologyAmong 113 patients who completed 12 weeks of treatment, pain, sleep and mental-health scores improved more over time with crisugabalin.
NeurologyIn 64 adults with painful DPN, 72.8% on active laser achieved at least 30% pain reduction versus 32.3% on sham at three weeks.
NeurologyAmong 41 patients still in pain on pregabalin or gabapentin, 53.7% had at least 30% relief and 46.3% at least 50% after switching.
NeurologyBy three months, 90% of MS patients on lacosamide reported clinical improvement versus 37.5% on placebo, with lower pain severity and interference.
NeurologyIn 76 patients with chronic radicular low back pain, sedation was 7.9% with pregabalin–duloxetine versus 31.6% with pregabalin–amitriptyline, with a trend to better pain relief.
NeurologyThe trial missed its 6-week primary endpoint, but by week 12 duloxetine reduced pain versus placebo while venlafaxine did not.
NeurologyAcross 18 studies, RZV protected immunocompetent adults over 50 against shingles, reduced zoster ophthalmicus and likely postherpetic neuralgia, with protection for at least 11 years.
NeurologyA new SR tablet gave the same daily exposure as standard mirogabalin with linear pharmacokinetics and no accumulation, supporting efficacy trials.
NeurologyOver eight weeks, CIPN20 scores fell by 23.8 points, with improvements in sensory, motor and autonomic symptoms, pain interference and quality of life.
NeurologyIn a 12-week phase 3 trial of 296 patients, once-daily SR pregabalin gave sleep, physical and global-impression benefits comparable to immediate-release pregabalin.
NeurologyAcross six RCTs, intravenous ketamine was superior to placebo for halving pain (RR 2.79), with a stronger effect at 400 µg/kg, but adverse effects were three times more frequent.
NeurologyIn 7,599 matched pairs aged 65 and older, GI bleeding occurred in 2.49% of duloxetine starters and 1.22% of gabapentin starters, mostly upper GI.
NeurologyIn adults aged 40 and over, LZ901 had 91.6% efficacy against herpes zoster and 95.9% against PHN at 12 months, with few severe reactions.
NeurologyAcross 12 RCTs and 4,542 patients, duloxetine 120 mg ranked highest for pain relief with high-certainty evidence, ahead of mirogabalin 30 mg and flexible-dose pregabalin.
NeurologyIn a small Iranian trial, NRS pain fell from 7.6 to 3.2 with a synbiotic versus 7.8 to 6.4 with placebo, alongside better sleep.
NeurologyIn 90 patients, sacral nerve block gave lower pain at 1, 3 and 6 months and doubled the rate of good outcomes at six months (75.6% vs 37.5%).
NeurologyIn 60 patients refractory to TCAs or SNRIs, 30% relief at week 9 was 38% with the combination and 32% with buprenorphine alone, a non-significant difference.
NeurologyGabapentinoids damp excitatory signalling while duloxetine restores descending inhibition, giving a rationale for combination therapy in residual chronic pain.
NeurologyIn 116 women with intercostobrachial neuralgia, pain fell by 3 points at six months in those who started on pregabalin and then switched to a capsaicin patch.
NeurologyAcross 6,611 patients, calcium-channel ligands such as pregabalin, mirogabalin, gabapentin and crisugabalin cut pain and sleep interference and raised 30% and 50% responder rates.
NeurologyMedian pain fell from 8 to 5 on VAS after three months of swish-and-spit pregabalin, with 46% achieving at least 30% relief and no serious side effects.
NeurologySummarising 22 systematic reviews, the authors found gabapentinoids effective in DPN, cancer-related neuropathic pain, spinal cord injury and several refractory pain states, with pregabalin faster-acting than gabapentin.
NeurologyAdding sinomenine sustained-release tablets to pregabalin improved pain, sleep and quality of life and lowered inflammatory markers over four weeks.
NeurologyIn 80 patients aged 50–70, cobratide and pregabalin reduced NRS pain by 6.00 and 5.63 points at day 28, a non-significant difference.
NeurologyAt 12 weeks, 9.1% of patients given pregabalin 150 mg/day after spinal cord injury had developed central neuropathic pain, versus 52.6% of untreated controls.
NeurologyA Chinese expert panel from six specialties concluded that pregabalin is effective and generally well tolerated across a broad range of peripheral neuropathic pain conditions.
NeurologyPooling 19 studies and 4,483 patients, the two drugs did not differ on pain from week 1 to week 12; pregabalin caused less nausea, anorexia and diarrhoea.
NeurologyIn 151 patients with type 2 diabetes, pregabalin 150 mg/day lowered VAS pain by about 20 mm over 12 weeks, statistically non-inferior to the combination with alpha-lipoic acid.
NeurologyIn 160 patients, 74.5–82.8% achieved clinically meaningful relief by week 8; adding gabapentin or amitriptyline gave no further gain.
NeurologyIn 109 older patients with neuropathic pain and heavy polypharmacy, all improved over a year on gabapentinoids, and pregabalin reduced VAS faster than gabapentin.
NeurologyIn a crossover pilot, the gel reduced average pain by 0.9 points by day 3, with an NNT of 8 for 50% relief.
NeurologyIn 199 patients with colorectal cancer, the response rate on placebo (68.0%) was similar to duloxetine 30 mg (65.2%) or 60 mg (66.0%).
NeurologyIn 729 patients from three placebo-controlled trials, about 42% on 300 or 600 mg/day halved their pain versus about 15% on placebo, with benefit at both HbA1c ≤8% and above 8%.
NeurologyAcross nine Indian hospitals, 185 patients on pregabalin PR 75 mg plus etoricoxib 60 mg had a 3.4-point NRS drop at eight weeks, and rescue medicine use fell from 67% to 19%.
NeurologyPooling three randomised trials in 471 patients, the combination lowered NRS pain by a further 1.82 points versus monotherapy without a significant rise in adverse events.
NeurologyAfter an end-of-phase 2 meeting raised no concerns, Lexicon will test once-daily pilavapadin 10 mg against placebo in two 12-week phase 3 studies.
NeurologyA literature review found pregabalin more effective than carbamazepine and venlafaxine, comparable to amitriptyline, and better tolerated overall.
NeurologyA review of cohort studies found that gestational pregabalin exposure was not associated with major congenital malformations or adverse birth and neurodevelopmental outcomes once confounders were considered.
NeurologyIn 60 patients with diabetic neuropathic pain, the pregabalin–duloxetine combination lowered VAS by 2.23 points versus 1.35 with pregabalin–nortriptyline, with better sleep and depression scores.
NeurologyGrade 2–3 neuropathy at cycle 12 occurred in 51.6% on duloxetine versus 80.7% on gabapentin, with lower nerve-injury biomarkers.