COMMENTARY

Caution Urged on Use of Opioids for Diabetic Neuropathy 

Dr Andrew J.M. Boulton, DSc, FRCP

Disclosures

June 11, 2019

This transcript has been edited for clarity.

Hi, my name is Andrew Boulton, professor of medicine at the University of Manchester, and visiting professor, University of Miami.

This year, it's been a pleasure to be on the programme committee for this American Diabetes Association (ADA) meeting here in San Francisco.

We've just had a topic discussed on the use of opioids and cannabinoids in painful diabetic neuropathy. When we selected this 6 to 9 months ago, I think we must have had foresight to realise that this is really going to be even more controversial now that, for example, in the United States, the state of Oklahoma is suing some pharmaceutical companies for aggressively promoting these agents, which they are claiming led to a number of deaths in the state.

We had two speakers today. The first was a pain expert talking about what evidence there is for the use of opioids in painful diabetic neuropathy. And the evidence is not really that strong, mainly small studies. In fact, the best evidence remains for the tricyclic drugs but of course these are plagued by quite frequent complications that are predictable, and extremely troublesome for the patient.

The second speaker showed that opioids are used in up to 60 to 70% of cases of painful diabetic neuropathy. I think it's fair to say that we all agreed these drugs should really be third or fourth line drugs, and only used for short periods of time.

Our first speaker also pointed out that tramadol, which is frequently used in western countries, the evidence supporting it strongly comes from one major trial from Harati and colleagues from Houston that was published around 20 years ago.

In fact, subsequent studies haven't shown such positive effects for tramadol in neuropathic pain.

So I think the message from this symposium is to use these very sparingly and certainly not as first or second line agents.

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