Table 1.

Pharmacological treatment options for painful neuropathy

Approach	Compound/measure	Dose per day	Remarks	NNT
Optimal diabetes control	Diet, oral antidiabetic drugs, insulin	Individual adaptation	Aim: A1C ≤6.5–7%
Pathogenetically oriented treatment	α-Lipoic acid (thioctic acid)*	600 mg i.v. infusion 600–1,800 mg orally	Duration: 3 weeks Favorable safety profile	6.3† 2.8–4.2†
First-line symptomatic treatment
TCAs	Amitriptyline	(10-)25–150 mg	NNMH: 15	2.1
	Desipramine	(10-)25–150 mg	NNMH: 24	2.2/3.2
	Imipramine	(10-)25–150 mg	CRR	1.3/2.4/3.0
	Clomipramine	(10-)25–150 mg	NNMH: 8.7	2.1
	Nortriptyline	(10-)25–150 mg	Plus fluphenazine	1.2
Selective serotonin norepinephrine
reuptake inhibitors	Duloxetine‡	(30-)60–120 mg	NNMH (60 mg): 18	5.3 (60 mg)
			NNMH (120 mg): 9	4.9 (120 mg)
	Venlafaxine	75–225 mg	NNMH (75–225 mg): 21	6.9 (75–225 mg)
			NNMH (150–225 mg): 17	4.6 (150–225 mg)
α2-δ ligands	Pregabalin‡	(50-)300–600 mg	NNMH (300 mg): 23	6.0 (300 mg)
			NNMH (600 mg): 11	4.0 (600 mg)
	Gabapentin	(300-)1,800–3,600 mg	Evidence weaker than for pregabalin	3.8/4.0
Second-line symptomatic treatments
Local treatment	Capsaicin (0.025%) cream	q.i.d. topically	Maximum duration: 6–8 weeks
Weak opioids	Tramadol	50–400 mg	NNMH: 7.8	3.1/4.3
Strong opioids	Oxycodone	10–100 mg	Add-on treatment pioid-specific problems	2.6

*Available only in some countries;

†≥50% symptom relief after 3 and 5 weeks;

‡licensed in U.S. and European Union; CRR, concentration-response relationship; NNMH, number needed for major harm.