Condition

Peripheral Neuropathy

Nerve damage causing pain and numbness

206M
People Affected
50
Active Trials
6.2M
New Cases/Year
25K
Deaths/Year

Treatment Rankings

Ranked by evidence volume first. Medicine has spent centuries ranking things by vibes. This is an improvement.

1
Duloxetine
80% Effectiveness• 88% Confidence• 60% Safety• 43 trials• 25K participants
HIGH EvidenceExcellent ValueDose: 30-60 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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Morphine💊
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60
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

12%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

10

Common Side Effects:

Nausea: 25%
Dry mouth: 15%
Dizziness: 12%
Constipation: 10%

Annual Cost of Care

Drug Cost

$250

Monitoring

$250

Side Effects

$100

Total Annual

$600

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$20,000/QALY

Cost per Remission

$5,000

Cost per Responder

$1,090.91

Treatment Outcomes
Primary Outcomes
Average Daily Pain Score (NRS 0-10)6.8/10
-35% (-2.4 points)
Worst Pain Score (NRS 0-10)8.0/10
-30% (-2.4 points)
Pain Interference with Sleep (BPI-SF 0-10)6.0/10
-25% (-1.5 points)
Secondary Benefits
Health-Related Quality of Life (SF-36 Bodily Pain subscale)35/100
+25% (+9 points)
Depressive Symptoms (PHQ-9 score 0-27)12/27
-30% (-3.6 points)
Physical Functioning (SF-36 Physical Functioning subscale)40/100
+20% (+8 points)
Common Side Effects
Nausea
+25%
Dry mouth
+15%
Dizziness
+12%

Clinical Trial Phases:

Phase 3Phase 4
2
Pregabalin
80% Effectiveness• 88% Confidence• 58% Safety• 154 trials• 20K participants
HIGH EvidenceGood ValueDose: 150-600 mg daily in 2-3 divided doses
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Comparative Safety Scale(Higher is safer)

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Meth💀
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58
DangerousModerateSafe

Time to Effect

1 week

Duration

lifetime

Response Rate

50%

Remission Rate

8%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

8

Common Side Effects:

Dizziness: 25%
Somnolence: 25%
Peripheral edema: 8%
Weight gain: 7%

Annual Cost of Care

Drug Cost

$400

Monitoring

$250

Side Effects

$100

Total Annual

$750

Cost-Effectiveness

GOOD

QALYs Gained

0.07

ICER

$65,000/QALY

Cost per Remission

$9,375

Cost per Responder

$1,500

Treatment Outcomes
Primary Outcomes
Daily Pain Score6.5/10 (NRS)
-35% (-2.3 points)
Sleep Interference Score6.0/10 (NRS)
-30% (-1.8 points)
Short-form McGill Pain Questionnaire (SF-MPQ) Total Score25/45 points
-35% (-8.8 points)
Secondary Benefits
Health-Related Quality of Life (SF-36 Physical Component Summary)35/100 points
+12% (+4.2 points)
Anxiety Severity (HADS-A)12/21 points
-25% (-3.0 points)
Daily Activity Interference Score6.0/10 (NRS)
-25% (-1.5 points)
Common Side Effects
Dizziness
+25%
Somnolence
+25%
Peripheral edema
+8%

Clinical Trial Phases:

Phase 3Phase 4
3
Venlafaxine
75% Effectiveness• 85% Confidence• 60% Safety• 5 trials• 18K participants
HIGH EvidenceExcellent ValueDose: 75-225 mg daily (extended-release)
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
Antibiotics💉
Tylenol💊
Exercise🏃
Water💧
60
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

12%

Number Needed to Treat (NNT)

7

Number Needed to Harm (NNH)

10

Common Side Effects:

Nausea: 25%
Insomnia: 20%
Dizziness: 15%
Increased blood pressure: 7%

Annual Cost of Care

Drug Cost

$200

Monitoring

$250

Side Effects

$100

Total Annual

$550

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.07

ICER

$25,000/QALY

Cost per Remission

$4,583.33

Cost per Responder

$1,000

Treatment Outcomes
Primary Outcomes
Average Pain IntensityNRS (0-10) score: 6.8
-35% (-2.4 points)
Worst Pain IntensityNRS (0-10) score: 8.2
-30% (-2.5 points)
Pain InterferenceBPI-SF Pain Interference (0-10): 6.0
-25% (-1.5 points)
Secondary Benefits
Sleep InterferenceBPI-SF Sleep Interference (0-10): 7.0
-20% (-1.4 points)
Health-Related Quality of LifeEQ-5D-5L VAS (0-100) score: 55
+10% (+5.5 points)
Depression SymptomsPHQ-9 score (0-27): 12
-25% (-3.0 points)
Common Side Effects
Nausea
+25%
Insomnia
+20%
Dizziness
+15%

Clinical Trial Phases:

Phase 3Phase 4
4
Gabapentin
75% Effectiveness• 83% Confidence• 62% Safety• 72 trials• 30K participants
MODERATE EvidenceExcellent ValueDose: 900-3600 mg daily in 3 divided doses
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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62
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

lifetime

Response Rate

48%

Remission Rate

7%

Number Needed to Treat (NNT)

8

Number Needed to Harm (NNH)

8

Common Side Effects:

Dizziness: 20%
Somnolence: 20%
Peripheral edema: 7%
Fatigue: 5%

Annual Cost of Care

Drug Cost

$180

Monitoring

$250

Side Effects

$100

Total Annual

$530

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.06

ICER

$15,000/QALY

Cost per Remission

$7,571.43

Cost per Responder

$1,104.17

Treatment Outcomes
Primary Outcomes
Average Daily Pain Score6.8 points on an 11-point scale (0-10)
-35% (-2.4 points)
Pain Interference with Sleep6.2 points on an 11-point scale (0-10)
-30% (-1.9 points)
Worst Pain Score8.5 points on an 11-point scale (0-10)
-25% (-2.1 points)
Secondary Benefits
Health-Related Quality of Life55/100 on EQ-5D Visual Analogue Scale
+10% (+5.5 points)
Physical Functioning40/100 on SF-36 Physical Functioning subscale
+12% (+4.8 points)
Number of Painful Days per Month25 days/month
-20% (-5 days/month)
Common Side Effects
Dizziness
+20%
Somnolence
+20%
Peripheral edema
+7%

Clinical Trial Phases:

Phase 3Phase 4
5
Amitriptyline
70% Effectiveness• 80% Confidence• 50% Safety• 25 trials• 35K participants
MODERATE EvidenceExcellent ValueDose: 10-150 mg daily
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
Alcohol🍺
Morphine💊
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Tylenol💊
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50
DangerousModerateSafe

Time to Effect

2-4 weeks

Duration

lifetime

Response Rate

55%

Remission Rate

12%

Number Needed to Treat (NNT)

4

Common Side Effects:

Dry mouth: 40%
Sedation/Drowsiness: 30%
Constipation: 20%
Dizziness/Orthostatic hypotension: 15%

Annual Cost of Care

Drug Cost

$90

Monitoring

$300

Side Effects

$200

Total Annual

$590

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.06

ICER

$10,000/QALY

Cost per Remission

$4,916.67

Cost per Responder

$1,072.73

Treatment Outcomes
Primary Outcomes
Pain Intensity (NRS 0-10)6.5/10
-35% (-2.3 points)
Sleep Interference due to Pain (NRS 0-10)7.0/10
-40% (-2.8 points)
Neuropathic Pain Symptom Inventory (NPSI) Total Score50/100
-30% (-15 points)
Secondary Benefits
Quality of Life (SF-36 Bodily Pain Scale)35/100
+20% (+7 points)
Depressive Symptoms (BDI-II Total Score)22/63
-25% (-5.5 points)
Pain Interference with General Activity (PEG scale 0-10)7.0/10
-30% (-2.1 points)
Common Side Effects
Dry mouth
+40%
Sedation/Drowsiness
+30%
Constipation
+20%

Clinical Trial Phases:

Phase 3Phase 4
6
Topical Capsaicin (8% patch)
65% Effectiveness• 80% Confidence• 80% Safety• 8 trials• 8K participants
MODERATE EvidenceExcellent ValueDose: One 8% patch applied for 60 minutes
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
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80
DangerousModerateSafe

Time to Effect

1-2 weeks

Duration

Applied every 3 months

Response Rate

45%

Remission Rate

3%

Number Needed to Treat (NNT)

8

Common Side Effects:

Application site pain: 70%
Application site erythema: 60%
Burning sensation: 50%

Annual Cost of Care

Drug Cost

$3,600

Monitoring

$1,200

Side Effects

$50

Total Annual

$4,850

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.03

ICER

$40,000/QALY

Cost per Remission

$161,666.67

Cost per Responder

$10,777.78

Treatment Outcomes
Primary Outcomes
Average Daily Pain Score7.0/10 NRS (0=no pain, 10=worst possible pain)
-35.7% (-2.5 points)
Worst Pain Score (BPI-SF)8.0/10 NRS (0=no pain, 10=worst possible pain)
-35% (-2.8 points)
Neuropathic Pain Symptom Inventory (NPSI) Total Score50/100 NPSI score (0=no symptoms, 100=worst symptoms)
-35% (-17.5 points)
Pain Interference with General Activity (BPI-SF)6.5/10 NRS (0=no interference, 10=complete interference)
-30.8% (-2.0 points)
Secondary Benefits
Pain Interference with Sleep (BPI-SF)7.0/10 NRS (0=no interference, 10=complete interference)
-28.6% (-2.0 points)
Health-Related Quality of Life (EQ-5D VAS)50/100 EQ-5D VAS (0=worst health, 100=best health)
+20% (+10 points)
Depression Score (HADS-D)10/21 HADS-D score (0-7=normal, 8-10=mild, 11-14=moderate, 15-21=severe)
-20% (-2.0 points)
Common Side Effects
Application site pain
+70%
Application site erythema
+60%
Burning sensation
+50%

Clinical Trial Phases:

Phase 3Phase 4
7
Topical Lidocaine (5% patch)
60% Effectiveness• 75% Confidence• 85% Safety• 7 trials• 9K participants
MODERATE EvidenceExcellent ValueDose: Up to 3 patches for up to 12 hours/day
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Comparative Safety Scale(Higher is safer)

Cyanide☠️
Meth💀
Cigarettes🚬
Chemo☢️
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Morphine💊
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85
DangerousModerateSafe

Time to Effect

30 minutes to 2 hours

Duration

Applied daily as needed

Response Rate

38%

Remission Rate

2%

Number Needed to Treat (NNT)

6

Common Side Effects:

Application site erythema: 8%
Application site edema: 5%
Application site pruritus: 5%

Annual Cost of Care

Drug Cost

$2,400

Monitoring

$150

Side Effects

$20

Total Annual

$2,570

Cost-Effectiveness

EXCELLENT

QALYs Gained

0.02

ICER

$35,000/QALY

Cost per Remission

$128,500

Cost per Responder

$6,763.16

Treatment Outcomes
Primary Outcomes
NRS (Numeric Rating Scale) for Average Pain Intensity6.8/10
-30.9% (-2.1/10)
Brief Pain Inventory (BPI) - Average Pain Severity6.5/10
-27.7% (-1.8/10)
Short-form McGill Pain Questionnaire (SF-MPQ) - Pain Rating Index (PRI) total score25/45
-28% (-7.0/45)
Secondary Benefits
Brief Pain Inventory (BPI) - Pain Interference with General Activity6.0/10
-25% (-1.5/10)
Brief Pain Inventory (BPI) - Pain Interference with Sleep7.2/10
-25% (-1.8/10)
EQ-5D-5L Health State Index (Quality of Life)0.65
+12.3% (+0.08)
Common Side Effects
Application site erythema
+8%
Application site edema
+5%
Application site pruritus
+5%

Clinical Trial Phases:

Phase 3Phase 4