Evidence and clinical considerations for the use of serotonin and norepinephrine reuptake inhibitors for the treatment of painful neuropathy

Abstract

Introduction: Peripheral neuropathy is a painful condition that can lead to a reduction in quality of life. The pain, which stems from damaged, hyperexcitable neurons, does not respond to traditional analgesics. However, due to the underlying mechanism of pain, some antidepressants are effective in managing peripheral neuropathy. The purpose of this review is to evaluate the available literature on serotonin-norepinephrine reuptake inhibitors for the management of peripheral neuropathy and outline clinical considerations for choosing an agent. Methods: PubMed, Ovid/MEDLINE, and Scopus queries were conducted for relevant literature. Search types were limited to keyword searches and articles were limited to those published prior to March 31, 2015. Results: There were 19 randomized controlled trials included in this review. No articles were found investigating the use of desvenlafaxine, milnacipran, or levomilnacipran for treatment of neuropathy. Both duloxetine and venlafaxine improved pain severity scores for patients suffering from painful peripheral neuropathy compared to placebo. Discussion: Duloxetine and venlafaxine are able to decrease the severity of peripheral neuropathic pain. None of the trials found that either one of the therapies was able to completely eliminate pain for the patients, which should be an important counseling point for patients to understand. Additionally, patient-specific factors should be considered when choosing an agent, including comorbid disease states and potentially interacting medications.