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The anticonvulsant drug gabapentin has received attention recently as a treatment for chronic pain. Although scientists still don't know how it works in the body, the drug has been effective in alleviating several types of nerve pain. Diabetic peripheral neuropathy-burning or tingling pain in the extremities-is one of the most common complications of diabetes, with about 45 percent of diabetic patients experiencing this condition during their lifetimes.
Researchers at the Veteran Affairs San Diego Healthcare Systems in California recently studied 19 diabetic patients with chronic neuropathic pain. In a cross-over study, the patients first took one of the drugs for six weeks, then after a week off, took the other drug for six weeks. Half the patients started with gabapentin and the other half with amitriptyline, the drug most often used in treating diabetic neuropathy. Neither the patients nor their doctors knew which drug they were taking when.
The study resulted in a tie; neither drug proved superior in relieving the pain of diabetic neuropathy. Both treatments significantly reduced pain scores from baseline, with over half of patients reporting moderate or better pain relief. The two drugs produced similar side effects, except that dry mouth was worse with amitriptyline and continued through the study, while dizziness from gabapentin got better over the six weeks. Almost all patients experienced side effects from both drugs, including drowsiness, nausea, dry mouth, and dizziness. Adverse effects caused one patient taking gabapentin and two patients taking amitriptyline to quit the study.
The researchers concluded that the number of patients in their study was too small to allow them to see any real differences between the two treatments, but both seem to be effective. They pointed out that amitriptyline is cheaper than gabapentin, so until larger comparison studies are done, it's hard to know what role gabapentin should play in treating chronic pain associated with diabetic peripheral neuropathy.