Anticonvulsants, SNRIs, and Rubefacients Are Best Initial Choices for Chronic Pain Caused by Diabetic Neuropathy or Postherpetic Neuralgia.

Given the balance of benefits and harms, there is moderately good evidence for anticonvulsants (pregabalin [Lyrica] and gabapentin [Neurontin] were similarly effective and well tolerated) and serotonin-norepinephrine reuptake inhibitors (SNRIs; with duloxetine [Cymbalta] and venlafaxine being similarly effective and well tolerated) for treating diabetic neuropathy and postherpetic neuralgia. Rubefacients (usually salicylates) appear to be effective but are less well studied with low-quality evidence. Acupuncture, opioids, and tricyclic antidepressants cannot be recommended based on current evidence.