Vitamin B12 may be more effective than nortriptyline in improving painful diabetic neuropathy.
BACKGROUND
Despite many therapeutic options, painful diabetic neuropathy is still a common and challenging complication of diabetes mellitus and is often resistant to treatment with current modalities.


METHODS
In this randomized, single-blind clinical trial we compared the efficacy of parenteral vitamin B(12) and nortriptyline, for symptomatic improvement of pain, paresthesia, burning, freezing, stabbing and electrical sensation. Changes in nerve conduction parameters of amplitude, duration and latency were also compared.


RESULTS
One hundred patients (50 in each group) completed the study. After treatment, the pain score based on a visual analogue scale decreased 3.66 units in the vitamin B(12) group and 0.84 units in the nortriptyline group (P <0.001). Similarly, the paresthesia score decreased 2.98 units versus 1.06 units (P <0.001). The decrements of tingling sensation were 3.48 units versus 1.02 units (P <0.001). Changes in vibration, position, pinprick and nerve conduction parameters were not significant in two groups.


CONCLUSIONS
In conclusion, vitamin B(12) is more effective than nortriptyline for the treatment of symptomatic painful diabetic neuropathy.
Talaei
Afsaneh
A
Department of Endocrinology, Arak University of Medical Sciences, Arak, Iran.
Siavash
Mansour
M
Majidi
Hamid
H
Chehrei
Ali
A
D000293:Adolescent; D000328:Adult; D018712:Analgesics, Non-Narcotic / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D000927:Anticonvulsants / Q000009:adverse effects / Q000627:therapeutic use; D000929:Antidepressive Agents, Tricyclic / Q000009:adverse effects / Q000627:therapeutic use; D001786:Blood Glucose / Q000032:analysis; D003929:Diabetic Neuropathies / Q000188:drug therapy* / Q000503:physiopathology; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D007273:Injections, Intramuscular; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D009431:Neural Conduction / Q000187:drug effects; D009437:Neuralgia / Q000188:drug therapy*; D009474:Neurons / Q000187:drug effects*; D009661:Nortriptyline / Q000009:adverse effects / Q000627:therapeutic use*; D010147:Pain Measurement; D010292:Paresthesia / Q000188:drug therapy; D011795:Surveys and Questionnaires; D013997:Time Factors; D014805:Vitamin B 12 / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
D018712:Analgesics, Non-Narcotic; D000927:Anticonvulsants; D000929:Antidepressive Agents, Tricyclic; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008055:Lipids; D009661:Nortriptyline; D014805:Vitamin B 12; C517652:hemoglobin A1c protein, human