Table 4

Treatment for pain associated with DSPN (15,16,20,86,87)

Drug classAgentDoseNNT range 30–50% improvement**Common adverse eventsMajor adverse events
InitialEffective
Anticonvulsants
Pregabalin* (15,86,8894)25–75 mg, 1–3×/day300–600 mg/day3.3–8.3• Somnolence• Angioedema
• Dizziness• Hepatotoxicity
• Peripheral edema• Rhabdomyolysis
• Headache• Suicidal thoughts and behavior
• Ataxia• Seizures after rapid discontinuation
• Fatigue• Thrombocytopenia
• Xerostomia
• Weight gain
Gabapentin (15,86,96,105111)100–300 mg, 1–3×/day900–3,600 mg/day3.3–7.2• Somnolence• Stevens-Johnson syndrome
• Dizziness• Suicidal thoughts and behavior
• Ataxia• Seizures after rapid discontinuation
• Fatigue
Antidepressants
 Serotonin-norepinephrine reuptake inhibitorsDuloxetine* (15,86,94,96,98101)20–30 mg/day60–120 mg/day3.8–11• Nausea• Stevens-Johnson syndrome
• Somnolence• Hepatotoxicity
• Dizziness• Hypertensive crisis
• Constipation• Gastrointestinal hemorrhage
• Dyspepsia• Delirium
• Diarrhea• Myocardial infarction
• Xerostomia• Cardiac arrhythmias
• Anorexia• Glaucoma
• Headache• Suicidal thoughts and behavior
• Diaphoresis• Shift to mania in patients with bipolar disorder
• Insomnia• Seizures
• Fatigue• Severe hyponatremia
• Decreased libido• Fragility bone fractures
• Serotonin syndrome
• Neuroleptic malignant syndrome
Venlafaxine (15,16,20,86,87,126,127)37.5 mg/day75–225 mg/day5.2–8.4• Nausea• Same as duloxetine
• Somnolence
• Dizziness
• Constipation
• Dyspepsia
• Diarrhea
• Xerostomia
• Anorexia
• Headache
• Diaphoresis
• Insomnia
• Fatigue
• Decreased libido
Tricyclic antidepressantsAmitriptyline (16,110,112116)10–25 mg/day25–100 mg/day2.1–4.2• Xerostomia• Delirium
• Somnolence• Cardiac arrhythmias
• Fatigue• Conduction abnormalities
• Headache• Myocardial infarction
• Dizziness• Heart failure exacerbation
• Insomnia• Stroke
• Orthostatic hypotension• Seizures
• Anorexia• Hepatotoxicity
• Nausea• Bone marrow suppression
• Urinary retention• Suicidal thoughts and behavior
• Constipation• Shift to mania in bipolar disorder
• Blurred vision• Neuroleptic malignant syndrome
• Accommodation• Serotonin syndrome
• Disturbance• Severe hyponatremia
• Mydriasis• Fragility bone fractures
• Weight gain
Desipramine (113,118121,122)• Same as above• Same as above
Nortriptyline (15,16,86,87,113,114,120,121,123)• Same as above• Same as above
Opioids
Tramadol (15,16,86,87,109,130)50 mg, 1–2×/day210 mg/day3.1–6.4• Somnolence• Confusion
• Nausea• Seizures
• Vomiting• Cardiac arrhythmias
• Constipation• Hypertension
• Light-headedness• Hypersensitivity reactions
• Dizziness• Stevens-Johnson syndrome
• Headache
Tapentadol* (103,104,135)Immediate release:50–100 mg, 4–6×/dayImmediate-release: day 1: 700 mg; after day 1, 60 mg/dayN/A• Somnolence• Respiratory depression
• Nausea• Serotonin syndrome
Extended release:50 mg, 2×/dayExtended release:50 mg, 2×/day• Vomiting• Seizures
• Constipation• Hypertension
• Dizziness• Neonatal opioid withdrawal syndrome
  • NNT, number needed to treat. *FDA approved.

  • **FDA considers 30–50% improvement to be significant.