INTRODUCTION: Neuropathic pain poses a therapeutic challenge since it is multifactorial. It is thought to be governed by multiple mechanisms and has various clinical manifestations Current treatments are palliative and require use of different kinds of drugs which include anticonvulsants, tricyclic anti-depressants, non-opiod analgesics and opiods. Neuropathic pain is often highly refractory to treatment, with maximum reductions in pain intensity of 30% to 40% as the norm (2). Lamotrigine inhibits the release of glutamate by stabilizing the neural membrane through blocking activation of voltage-sensitive sodium channels and by inhibiting the presynaptic release of glutamate (3) which acts on the postulated pathophysiologic process of neuropathic pain which is the influx of sodium into the nerves and release of excitatory amino acids particularly glutamate.

OBJECTIVE: To assess the evidence from randomized controlled trials the efficacy of lamotrigine in reducing painful diabetic neuropathy.

DESIGN: Meta-analysis of 3 randomized trials identified through Medline/Pubmed, Google and Cochrane Library (2001 up to present). All comparisons were performed according to intent to treat principle. The studies were analyzed using Review Manager Version 5. Heterogeneity of dichotomous outcome was assessed using the Q test. Data were overviewed with random effects model.

RESULTS: Total of 266 patients with diabetic neuropathy was included. Patients were randomized to receive lamotrigine and placebo. The main outcome measure was changed in the mean a pain intensity score based on the numerical pain scale. Overall assessment showed that lamotrigine is efficacious in reducing painful diabetic neuropathy with a combined mean difference for primary outcome of -0.79 with a 95% confidence interval.

CONCLUSION: Based on this meta-analysis, lamotrigine is an effective and well-tolerated treatment for painful diabetic neuropathy.