title: Glyceryl trinitrate spray in the management of painful diabetic neuropathy: a randomized double blind placebo controlled cross-over study.
abstract: OBJECTIVE
  Various drugs are effective in the management of painful diabetic neuropathy, but none is completely satisfactory. The objective of this study is to test the effectiveness and safety aspect of glyceryl trinitrate (GTN) in the management of painful diabetic neuropathy as a nitric oxide (NO) donor with local vasodilating properties in spray form.
  
  
  METHODS
  Randomized double blind placebo controlled cross-over study.
  
  
  METHODS
  Fifty patients with painful diabetic neuropathy (type 2) were screened consecutively, out of which two were excluded (1 with HbA(1)c>11 and one withdrew his consent). The remaining 48 were given either drug (group A) or placebo (group B) in the first phase. After thorough clinical assessment in the first phase, quantitative assessment of pain was done by McGill Pain Questionnaire, Visual Analogue Score, Present Pain Intensity and 11 point Lickerts Scale, at the beginning and after 4 weeks, followed by 2 weeks wash out period and thereafter receiving 4 weeks of cross-over regimen. Adverse drug effects were assessed periodically.
  
  
  RESULTS
  Of the 48 patients, five dropped out, two in group A and three in group B. Both groups A and B experienced significant improvement in pain score in their drug phase of trial, when compared to placebo phase of other group (p<0.001). After crossing over the treatment arm, patients of group B observed significant improvement in all pain scores compared to group A (p<0.001). The numbers needed to treat (NNT) calculated on VAS as pain parameters came out to be 4. The drug was well tolerated by all the patients except palpitation and headache for some days in five patients.
  
  
  CONCLUSIONS
  GTN spray, a well tolerated drug, provides significant improvement in painful diabetic neuropathy. These data provide a basis for future trials for longer duration in a larger group of patients.
authors.affiliation: Department of Medicine, S.P. Medical College, Bikaner 334003, India. rpagrawal@sancharnet.in
authors.forename: R P
authors.initials: RP
authors.lastname: Agrawal
authors.forename: Ramdev
authors.initials: R
authors.lastname: Choudhary
authors.forename: Poornima
authors.initials: P
authors.lastname: Sharma
authors.forename: Srikant
authors.initials: S
authors.lastname: Sharma
authors.forename: R
authors.initials: R
authors.lastname: Beniwal
authors.forename: K
authors.initials: K
authors.lastname: Kaswan
authors.forename: D K
authors.initials: DK
authors.lastname: Kochar
mesh_terms: D000287:Administration, Topical; D001786:Blood Glucose / Q000032:analysis; D018592:Cross-Over Studies; D003929:Diabetic Neuropathies / Q000097:blood / Q000188:drug therapy* / Q000503:physiopathology; D004311:Double-Blind Method; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008875:Middle Aged; D005996:Nitroglycerin / Q000008:administration & dosage / Q000627:therapeutic use*; D018579:Patient Selection; D016896:Treatment Outcome
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D005996:Nitroglycerin