It is estimated that over 40 million Americans, and between 2.4-7% of the world’s population suffer from peripheral neuropathy (PN) with the most common etiologies being diabetic (60%), idiopathic (23%), and chemotherapy induced (10%) neuropathy. With a lack of evidence-based treatments available, patients use both nutritional supplements and prescription medications for neuropathic pain relief. Healthcare providers are often unaware of the evidence for the prescribed medications used in the treatment of PN from varying etiologies. In addition, healthcare providers often fail to adequately investigate the caue of PN in individual patients, or to follow-up with additional appointments to assess the success of treatment and to titrate medication for the relief of neuropathic pain.
Methods: A retrospective, cross-sectional analysis of the medication and supplements reported used by 45 patients attending a community-based, free peripheral neuropathy clinic was conducted. Medication and supplement data including name of the medication or supplement, dose and frequency were collected.
Results: The mean age of the patients in this sample was 66 (11.9) years of age, males (52%), and Caucasian (95%). Most patients were retired (67%) or disabled (14%). The most common prescription medications included duloxetine (28.6%), gabapentin (26.2), pregabalin (14.3%), acetaminophen/hydrocodone (Vicodin) (11.9%), cyclobenzaprine (Flexeril) (11.9%), and buproprion (7.1%). Twelve patients documented that they were taking opioids (26.7%). The most common nutritional supplements used were vitamin D (26.2%), vitamin B12 (16.7%), Vitamin B Complex (9.5%), & vitamin D + C (9.5%).
Conclusion: Medication use in PN is difficult due lack of standardized therapies. The etiology of PN can vary, impacting efficacy of treatment. Providers need to titrate upward consistently until optimal pain relief is obtained. The number of patients prescribed ineffective opioids for PN is evidence of the need for additional provider education and guidelines for the treatment of PN.