Date: {{$ActivityAssignDate}}

Dear Dr. {{ $doctorName }},

Subject: : A survey to assess the usage pattern of duloxetine in the management of diabetic peripheral neuropathy in India

The International Association for the Study of Pain (IASP) defines neuropathic pain as pain caused by a lesion or disease of the somatosensory nervous system. This definition replaces an older definition according to which neuropathic pain was “pain initiated or caused by a primary lesion, dysfunction, or transitory perturbation of the peripheral or central nervous system”.

Two changes are important in this change of definition: dysfunction and the neuronal lesion.

1. In the new definition of neuropathic pain, dysfunction is no longer accepted as a criterion because it is difficult to accept symptoms and soft signs as criteria if they cannot be verified objectively.

2. It is now specified that the lesion needs to affect the somatosensory system meaning that lesions or diseases outside the somatosensory pathways, e.g., the cerebellum, does not qualify as neuropathic.

Neuropathic pain is a chronic condition which represents a significant burden for patients, society and healthcare systems. The prevalence of neuropathic pain in the general population has been estimated at 6.9–10.0%.

Management includes effective pharmacotherapy options for patients with low back neuropathic pain like serotonin-norepinephrine reuptake inhibitors (duloxetine, venlafaxine), tricyclic antidepressants (amitriptyline, desipramine, nortriptyline), and gabapentinoid antiseizure medications (pregabalin, gabapentin). All have been shown to be more effective than placebo in randomized trials, and limited comparative data suggest that efficacy is similar across agents

Duloxetine is a selective serotonin and norepinephrine reuptake inhibitor that is approved by the FDA for major depressive disorder, generalized anxiety disorder, diabetic peripheral neuropathic pain, and fibromyalgia. Its mechanism of action is through the blockade of reuptake of serotonin (5-HT) and norepinephrine. Studies show that duloxetine inhibits 5-HT and norepinephrine uptake in the hypothalamic synaptosomes of rats with a preference for 5-HT.

Metanalysis assessing the benefits and harms of duloxetine for treating painful neuropathy and different types of chronic pain shows that there was moderate quality evidence that duloxetine reduced pain in both painful diabetic peripheral neuropathy and fibromyalgia. In diabetic peripheral neuropathic pain, a 50% or better improvement with duloxetine 60 mg per day was just over one and a half times more likely than with placebo.

This survey is conducted to assess the usage pattern of duloxetine in the management of diabetic peripheral neuropathy in India

As you will be spending some extra time to give your feedback on the questionnaire based on your clinical experience, we offer to pay you by cheque a professional fee of Rs {{$contractAmount}}, on receiving the completed Survey Questionnaire Form from you.

We trust you and we are partners in promoting safe and effective drug therapy. In that spirit we hope you will consent to participate in this study. If you do, please sign and return the enclosed reply along with your visiting card for accuracy of records.