title: Pharmacologic interventions for painful diabetic neuropathy: an umbrella systematic review and comparative effectiveness network meta-analysis (Protocol).
abstract: BACKGROUND
  Neuropathic pain can reduce the quality of life and independence of 30% to 50% of patients with diabetes. The comparative effectiveness of analgesics for patients with diabetic neuropathy remains unclear. The aim of the current work, therefore, was to summarize the evidence about the analgesic effectiveness of the most common oral and topical agents used for the treatment of peripheral diabetic neuropathy.
  
  
  METHODS
  We will use an umbrella approach (systematic review of systematic reviews) to identify eligible randomized controlled trials (RCTs) for the most common oral or topical analgesics for painful diabetic neuropathy. Two reviewers will independently determine RCT eligibility. Disagreement will be solved by consensus and arbitrated by a third reviewer. We will extract descriptive, methodological and efficacy data in duplicate. Results will be pooled and analyzed using classic random-effects meta-analyses and network meta-analyses to compute the absolute and relative efficacy of therapeutic options. We will use the I2 statistic and Cochran's Q test to assess heterogeneity. Risk of bias and publication bias, if appropriate, will be evaluated, as well as overall strength of the evidence.
  
  
  CONCLUSIONS
  This network meta-analysis aims to synthesize available direct and indirect evidence of effectiveness of analgesics in the treatment of painful diabetic neuropathy. The network approach will offer the opportunity to generate a ranking based on efficacy and along with known side effects, costs, and administration burdens will enable patients and clinicians to make choices that best reflect their preferences for treatment of painful diabetic neuropathy.
authors.affiliation: Division of Diabetes, Endocrinology, Metabolism and Nutrition, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA. Griebeler.marcio@mayo.edu
authors.forename: Marcio L
authors.initials: ML
authors.lastname: Griebeler
authors.forename: Apostolos
authors.initials: A
authors.lastname: Tsapas
authors.forename: Juan P
authors.initials: JP
authors.lastname: Brito
authors.forename: Zhen
authors.initials: Z
authors.lastname: Wang
authors.forename: Olivia J
authors.initials: OJ
authors.lastname: Phung
authors.forename: Victor M
authors.initials: VM
authors.lastname: Montori
authors.forename: M Hassan
authors.initials: MH
authors.lastname: Murad
mesh_terms: D006801:Humans; D000700:Analgesics / Q000627:therapeutic use; D057186:Comparative Effectiveness Research; D003929:Diabetic Neuropathies / Q000188:drug therapy; D000078202:Systematic Reviews as Topic; D000071076:Network Meta-Analysis as Topic
chemical_list: D000700:Analgesics