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Diabetes
Pain Management

Cheaper Remedies Should Rule for Diabetes Nerve Pain

Millions of people with diabetes take medicine to ease the shooting, burning nerve pain that their disease can cause. Research suggests that no matter which medicine their doctorS prescribe, they’ll get relief. However, some of those medicines cost nearly 10 times as much as others, apparently with no major differences in how well they ease pain, according to a pair of University of Michigan Medical School experts who published a commentary in November 2014 in the Annals of Internal Medicine.

A release from the university explains that this finding makes cost — not effect — a crucial factor in deciding which medicine to choose for diabetic neuropathy, or diabetes nerve pain.
The U-M commentary accompanies a paper from Mayo Clinic researchers and their colleagues, who analyzed a wide range of data from clinical trials of different treatments for painful diabetic neuropathy. The Mayo-led team concluded that several options appear to work well, though they need to be compared head-to-head to tell for sure which is best.

Until new studies can make those head-to-head comparisons, say the U-M experts, doctors should consider the cost of the drug, and any other conditions a patient has, when deciding what to prescribe.

The release notes that Brian Callaghan, M.D., the article’s first author, says the new Mayo study, national guidelines, and other efforts have focused on how well different treatments work against diabetic nerve pain. Half of all people with diabetes develop neuropathy sometime during their experience with the disease, and it can keep patients from exercising or walking. Neuropathy plays a role in many diabetes complications.

But cost hasn’t figured into these studies, he says. That’s why he and fellow U-M neurologist Eva Feldman, M.D., Ph.D., decided to look at the dollars side of diabetic neuropathy for their article.

“These treatments all work about the same, but what’s different is their side effects and cost. The older medications are an order of magnitude cheaper, about $15 to $20 a month, compared with the newer ones at nearly $200 per month,” he says. “Patients are on these medications for many years, and it really starts to add up. Given that the effects of the medications are similar, why should we start patients on the expensive drugs until we’ve determined whether or not they respond to the less-expensive ones?”

The newer drugs, of course, have marketing campaigns behind them – and in the case of diabetic neuropathy, their manufacturers may have sought and received specific approval for diabetic neuropathy from the Food and Drug Administration.

The newer drugs have earned the highest level of recommendation in national treatment guidelines, which requires that at least 80 percent of people taking part in a clinical trial complete it in order for the study to be considered for high-level guideline approval. This helps create an artificial appearance that the newer drug is the better choice, says Callaghan.

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