Comparative Effectiveness of Tricyclic Antidepressants, Serotonin–Norepinephrine Reuptake Inhibitors, and Anticonvulsants for Diabetic Painful Neuropathy: A Systematic Review and Meta-Analysis

Introduction

Diabetic painful neuropathy (DPN) is one of the most common and debilitating complications of diabetes, substantially impairing the quality of life of patients. In the absence of disease-modifying therapies, treatment remains focused on symptomatic pain control with non-opioid pharmacologic agents; however, comparative evidence guiding optimal medication selection remains limited. Using a systematic review, pairwise meta-analysis, and network meta-analysis, this study compares the effectiveness of current non-opioid-based treatments, including amitriptyline, duloxetine, gabapentin, and pregabalin, for pain reduction in patients with DPN.