Medical Literature Review

PubMed is a service of the U.S. National Library of Medicine that includes over 18 million citations from MEDLINE and other life science journals for biomedical articles back to 1948. PubMed includes links to full text articles and other related resources. This is a valuable resource that we can use to obtain information on peripheral neuropathy (PN). There are over a hundred medical articles a month written on PN.

Dr. William B. Donovan, MD, reviews these references and selects articles that would appear to be most interesting to neuropathy patients. He focuses on articles on prevention, evidenced-based treatment, alternative treatment, and novel research. Even if you don't look at the articles themselves, you'll find useful information in the summaries Dr. Donovan provides.

This is the primary link to the PubMed website: www.ncbi.nlm.nih.gov/sites/entrez.

After you get to PubMed, you will see a line that says “Search PubMed” followed by “for” and a space. Every article in the NLM is given a PMID, an eight digit identification number. Type the PMID of any article you are interest in into the space after the “for” and click on “Go” at the end of the space (or press the ENTER key on your keyboard). You will then see a one paragraph abstract of the article appear, as well as links to related articles.

Here are the PMIDs to articles Dr. Donovan recommends.

19801049 Under the auspices of the International Association for the Study of Pain, a consensus process developed evidence-based guidelines for the management of neuropathic pain, recommending tricyclic and dual uptake inhibitors of serotonin and norepinephrine (e.g., Cymbalta®), gabapentin.

19921145 A randomized, controlled study of diabetics with varying degrees of peripheral neuropathy were given twice weekly physiotherapeutic group training gait and balance exercises as well as function-oriented strengthening over twelve weeks. At six months there was significant improvement in balance, gait, mobility and strength.

20805210 A study from McGill University of post traumatic or post-surgical patients with chronic neuropathic pain. A 25 mg dose of 9.4% smoked THC (marijuana) resulted in improved quality of sleep and decreased time to get to sleep. Adverse effects included cough, dry eyes, burning sensations, numbness and dizziness.

17713854 An animal study from Trakya University showing decreased myelin sheath breakdown in diabetic sciatic nerves following treatment with Nigella Sativa.

12722128 A detailed discussion from King Saud University of the medical literature and beneficial effects of the Indian herb Nigella Sativa (kalonji), including analgesia.

18600579 A discussion from the University of Toronto of fish consumption, omega-3 polyunsaturated fatty acids and docosahexaenoic acid (DHA) in the prevention and treatment of neurological disorders.

18474189 A review of mirror visual feed back (tricking oneself into seeing the unaffected body part on the affected side of the body) as a way of decreasing neuropathic pain and normalizing movement.

18178525 The ICE Study,”…the largest reported trial of any CIDP (chronic inflammatory demylinating polyradiculoneuropathy) treatment, shows the short-term and long-term efficacy and safety of IGIV-C (intravenous immune globulin) and supports use of IGIV-C as a therapy for CIDP.” study of diabetic patients found that those with neuropathy had increased levels of vascular endothelial growth factor (VEGF), the same agent that is involved in diabetic retinopathy and wet age-related macular degeneration.

19590482 A study from Taiwan of carpal tunnel syndrome (wrist pain) showed no difference between those treated with corticosteroid and those receiving acupuncture.

19557864 It is hypothesized that reflex sympathetic dystropathy, now known as complex regional pain syndrome (pain, hypersensitivity, sweat, edema, discoloration), may be a post traumatic small fiber peripheral neuropathy.

19588419 A review of the University of Oxford of 19 randomized control trials of pregabalin (Lyrica®) 600mg daily showed a minimum number of patients needed to treat (NNT), to achieve at least 50% pain relief was 5.6 for diabetic neuropathy and 5.0 for post-herpetic neuralgia.

19796802 This study at Queen’s University, Ontario, found that the antidepressant nortriptyline (Pamelor®) in combination with the anticonvulsant gabapentin (Neurontin®) controlled neuropathic pain more effectively than either medication alone.

19301378 An extensive Columbia University review of chronic demylinating polyradiculoneuropathy (CIDP), emphasized well-documented response to IVIg, plasmapheresis and corticosteroids—as well as lesser evidence supporting other agents: cyclophosphamide, rituximab, azothioprine, cyclosporine, interferon, fludarabine, mycophenolate, mofatil, and etanercept.

19655114 An extremely detailed monograph outlining possible mechanisms whereby nerve injury results in chronic pain—mediated by neuroinflammation, release of inflammatory cytokines, followed by hypersensitivity of the dorsal root ganglia, peripherally and later centrally in the dorsal horn of the spinal cord. Possible intervention using cytokine antibodies, e.g., tumor necrosis factor alpha, is suggested.

17713854 An animal study from Trakya University showing decreased myelin sheath breakdown in diabetic sciatic nerves following treatment with Nigella Sativa.

12722128 A detailed discussion from King Saud University of the medical literature and beneficial effects of the Indian herb Nigella Sativa (kalonji), including analgesia.

17713854 An animal study from Trakya University showing decreased myelin sheath breakdown in diabetic sciatic nerves following treatment with Nigella Sativa.

12722128 A detailed discussion from King Saud University of the medical literature and beneficial effects of the Indian herb Nigella Sativa (kalonji), including analgesia.

17713854 An animal study from Trakya University showing decreased myelin sheath breakdown in diabetic sciatic nerves following treatment with Nigella Sativa.

12722128 A detailed discussion from King Saud University of the medical literature and beneficial effects of the Indian herb Nigella Sativa (kalonji), including analgesia.

18403272 A UC Davis double-blind, placebo- controlled crossover study of neuropathic pain demonstrated analgesic response to smoking 3.5% as well as 7% cannabis (marijuana).

18646138 This Johns Hopkins review of the Cochrane Data Base of 142 studies in respect to symmetrical diabetic peripheral neuropathy “ failed to identify a single randomized controlled trial or any well designed prospective study controlling for the non-operated limb that showed improvements in predefined points after decompressive surgery.

17977931 Although we all know of PN cases who have claimed benefit from Anodyne® monochromatic infrared photo energy treatment, This TAMU double-blind, randomized, sham-controlled clinical trial failed to show significant benefit for sensory neuropathy.

17885349 A Stanford study demonstrating decreased neuropathic pain in older more severe cases following intravenous lidocaine (Xylocaine®).

18085141 A study from Sichuan demonstrating more post-herpetic pain alleviation from ear point taping and pressing combined with acupoint injection than Western medication.

18646102 A review of the treatment of meralgia paresthetica (pain in the lateral thigh) from Charring Cross Hospital revealed over 80% response to either injection with local anesthetic/corticosteroid, or surgery; however, another study reported a 69% spontaneous recovery, without treatment.

18673529 An Oxford study of fibromyalgia and diabetic neuropathy showed at least 50% pain reduction over 12 weeks for duloxetine (Cymbalta®) compared to placebo.

18774507 This Johns Hopkins review of three randomized controlled studies of 776 pregabalin (Lyrica®) and 258 controls of painful diabetic peripheral neuropathy found over four times the likelihood of at least 50% improvement with the active drug.

17883740 A Johns Hopkins study of neuropathic pain found over a third reduction in pain and increase in daytime activity with the use of transdermal fentanyl (Duragesic®).

18262450 A double-blind placebo-controlled study at King’s College Hospital found that controlled-release oxycodone (Oxycontin®) added to gabapentin (Neurontin®) reduces diabetic neuropathic pain by a third , and improves sleep quality.

18541884 A study at Mt. Sinai Medical Center found that the application of a high concentration capsaicin dermal patch desensitized cutaneous pain receptors in HIV-associated distal sensory neuropathy.• 17943857 In a Cochrane Database study of 61 trials of antidepressants for neuropathic pain, it was concluded that venlafaxine (Effexor®) and tricyclic antidepressants are effective.

18413214 Venlafaxine (Effexor®) is a combination norepinephrine-serotonin uptake inhibitor like duloxetine (Cymbalta®), the latter approved for use with peripheral neuropathy by the FDA. This study found venlafaxine to be safe, effective and well-tolerated as a treatment for the pain of distal symmetrical sensorimotor polyneuropathy.

17875242 A study from Spain found that, compared to gabapentin (Neurontin®), pregabalin (Lyrica ®) was more cost-effective with greater and faster pain reduction.

19160200 Cochrane Database—IVIg for CIDP

9252116 Mayo study of shingles prevention

19208243 Meta-analysis duloxetine vs. pregabalin for PN

18688212 UC Santa Barbara—cannabis for neuropathic pain

19224814 Topical lidocaine for PN

19499849 A Neapolitan study of 112 with carpal tunnel syndrome revealed significant improvement in symptoms and function when multivitamin controls were compared with a combination of alpha-lipoic acid 600mg. plus gamma-linolenic acid 360mg. daily.

19141719 A randomized study of diabetic neuropathy patients, 89 treatment cases and 78 controls, demonstrated that silicon orthotics protected the feet from the development of painful hyperkeratotic lesions.

19246421 In a double blind crossover study in Taipei of botulinum toxin type A for diabetic neuropathy, there was significant improvement at 3 months post-injection.

19406920 A study of over 5000 participants from community surveys in Singapore demonstrated that peripheral neuropathy incidence increased gradually with the level of fasting blood sugar, even at levels below the threshold for diabetes mellitus diagnosis.

19277838 An Italian study of CT-guided pudendal nerve block for pudendal neuralgia achieved relief of anoperineal pain, 92% at 12 months.

19555786 Chronic abdominal wall pain due to peripheral nerve impingement, often mistaken for intra-abdominal pathology, can be diagnosed by local anesthetic block of trigger points, and relieved by surgically releasing the nerve that is trapped by the muscle sheath.

19432499 In a double-blind placebo-controlled multinational trial with post-herpetic neuralgia, improvement of pain, allodynia, quality of life and sleep was achieved with 5% lidocaine plaster applied up to 12 hours daily.

17943857 In a Cochrane Database study of 61 trials of antidepressants for neuropathic pain, it was concluded that venlafaxine (Effexor®) and tricyclic antidepressants are effective.

17875242 A study from Spain found that, compared to gabapentin (Neurontin®), pregabalin (Lyrica ®) was more cost-effective with greater and faster pain reduction.

17883740 A Johns Hopkins study of neuropathic pain found over a third reduction in pain and increase in daytime activity with the use of transdermal fentanyl (Duragesic®).

18940920 A summary of studies done showing decreased pain and increased nerve regeneration in diabetic PN with acetyl-L-carnitine.

17914029 A study by CDC of adult diabetics showing PN to be associated with low levels of polyunsaturated fatty acid in the diet.

19301937 A study from the University of Schleswig- Holstein comparing oral pregabalin (Lyrica®) with lidocaine 5% medicated plaster found that the efficacy was comparable, but there were 90% fewer adverse events with the local treatment.

18796160 An Albert Einstein College of Medicine study of painful diabetic neuropathy showing over twice the response rate for pregabalin (Lyrica®) at 49%, compared with placebo,

19387178 A Johns Hopkins study of sciatica showing at least a 50% reduction in pain for the majority of patients at six months following nerve root injection with etanercept (Embrel®).

19243312 A University of Leicester review of studies demonstrating prevention and amelioration of diabetic neuropathy with proinsulin C-peptide.

19004197 A Guangzhou University study comparing the effectiveness of acupuncture plus acupointinjection vs. oral carbamazepine (Tegretol®), for occipital neuralgia, with the former being more effective.

18636234 A meta-analysis by Wake Forest University demonstrated increased functionality and chronic neuropathic pain relief from the H-Wave device manufactured by Electronic Waveform Lab.

19160200 Cochrane Database—IVIg for CIDP

19252116 Mayo study of shingles prevention

19208243 Meta-analysis duloxetine vs. pregabalin for PN

18688212 UC Santa Barbara—cannabis for neuropathic pain

19224814 Topical lidocaine for PN

17920770 Evidence-based first line treatment of neuropathic pain with gabapentin and pregabalin; tricyclic antidepressants and dual uptake inhibitors of norepinephrine and serotonin; and lidocaine patch

17065669 Alternative treatment of distal symmetric polyneuropathy with alpha-lipoic acid

17909094 Novel genetic research with nerve growth factor

18021866 Prevention of PN due to shingles

15616239 Promotion of nerve regeneration

17696592 Prevention of chemotherapy induced PN