Researchers from the Mayo Clinic evaluated the comparative effectiveness of oral and topical analgesics for diabetic neuropathy in a meta-analysis of parallel or crossover randomized, controlled trials that evaluated pharmacologic treatments for adults with painful diabetic peripheral neuropathy.

65 randomized, controlled trials involving 12 632 patients evaluated 27 pharmacologic interventions. Approximately one half of these studies had high or unclear risk of bias. Nine head-to-head trials showed greater pain reduction associated with serotonin–norepinephrine reuptake inhibitors (SNRIs) than anticonvulsants (standardized mean difference [SMD], −0.34 [95% credible interval {CrI}, −0.63 to −0.05]) and with tricyclic antidepressants (TCAs) than topical capsaicin 0.075%.

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