Antidepresivos de nueva generación en neuropatía diabética dolorosa

The incidence of diabetic neuropathy increases with the duration of diabetes and the degree of hyperglycaemia. Pain is one of the mostcommon and incapacitating symptoms of diabetic neuropathy and itspharmacological control is complex. The effectiveness of antidepressive agents has been described in different types ofneuropathic pain, but their effectiveness, when used as analgesics in painful diabetic neuropathy, still remains controversial. Objective: To review the possible role of new-generation antidepressive agents in the treatment of pain in diabetic peripheral neuropathy.This work has thus consisted of a meta-analysis for determining which antidepressive agent had the best analgesic potential in managing pain in patients suffering from painful diabetic neuropathy. Methods:This search covered the Cochrane, MEDLINE, EMBASE and LILACS databases, between January 2000 and August 2007. The followinginformation was obtained from each article: criteria for diagnosing diabetic neuropathy, patients’ age average, antidepressant drugreceived and dose, sample size, duration of the disease and treatmentfollow-up, outcome measurement, evaluation of pain and rescuemedication. Results: A combined RR: 1.67 (95% CI 1.38 – 2.02) wasobtained; this result indicated that the antidepressive agentduloxetine, was effective for controlling pain in diabeticneuropathy. The corresponding NNT for Duloxetine was established,according to our interests; NNT = 6 (95% CI 5- 8) for achievinggreater than 50% analgesia in patients suffering from painfuldiabetic neuropathy. Discussion: Antidepressive agents are frequently employed in the specific case of diabetic neuropathy; their analgesic benefit has been demonstrated.