Interventions for fatigue in peripheral neuropathy

Abstract

Background: Persistent feelings of fatigue (or subjective fatigue), which may be experienced in the absence of physiological factors, affect many people with peripheral neuropathy. A variety of interventions for subjective fatigue are available, but little is known about their efficacy or the likelihood of any adverse effects for people with peripheral neuropathy.

Objectives: To assess the effects of drugs and physical, psychological or behavioural interventions for fatigue in adults or children with peripheral neuropathy.

Search methods: On 5 November 2013, we searched the Cochrane Neuromuscular Disease Group Specialized Register, CENTRAL, MEDLINE, EMBASE, CINAHL Plus, LILACS and AMED. We also searched reference lists of all studies identified for inclusion and relevant reviews, and contacted the authors of included studies and known experts in the field to identify additional published or unpublished data. We also searched trials registries for ongoing studies.

Selection criteria: We considered for inclusion randomised controlled trials (RCTs) and quasi-RCTs comparing any form of intervention for fatigue management in adults with peripheral neuropathy with placebo, no intervention or an alternative form of intervention for fatigue. Interventions considered included drugs, pacing and grading of physical activity, general or specific exercise, compensatory strategies such as orthotics, relaxation, counselling, cognitive and educational strategies.

Data collection and analysis: Two review authors independently assessed risk of bias and extracted study data. We contacted study authors for additional information. We collected information on adverse events from the included trials.

Main results: The review includes three trials, which were all at low risk of bias, involving 530 people with peripheral neuropathy. The effects of amantadine from one randomised, double-blind, placebo-controlled, cross-over trial comparing amantadine with placebo for the treatment of fatigue in 80 people with Guillain-Barré syndrome (GBS) were uncertain for the proportion of people achieving a favourable outcome six weeks post-intervention (odds ratio (OR) 0.56 (95% confidence interval (CI) 0.22 to 1.35, N = 74, P = 0.16). We assessed the quality of this evidence as low. Two parallel-group randomised double-blind, placebo-controlled trials comparing the effects of two doses of ascorbic acid with placebo for reducing fatigue in adults with Charcot-Marie-Tooth disease type 1A (CMT1A) showed that the effects of ascorbic acid at either dose are probably small (standardised mean difference (SMD) -0.12 (95% CI -0.32 to 0.08, n = 404, P = 0.25)) for change in fatigue after 12 to 24 months (moderate quality evidence). Neither ascorbic acid study measured fatigue at four to 12 weeks, which was our primary outcome measure. No serious adverse events were reported with amantadine. Serious adverse events were reported in the trials of ascorbic acid. However,risk of serious adverse events was similar with ascorbic acid and placebo.

Authors' conclusions: One small imprecise study in people with GBS showed uncertain effects of amantadine on fatigue. In two studies in people with CMT1A there is moderate-quality evidence that ascorbic acid has little meaningful benefit on fatigue. Information about adverse effects was limited, although both treatments appear to be well tolerated and safe in these conditions.There was no evidence available from RCTs to evaluate the effect of other drugs or other interventions for fatigue in either GBS, CMT1A or other causes of peripheral neuropathy. The cost effectiveness of different interventions should also be considered in future randomised clinical trials.

1

Methodological quality summary: review authors' judgements about each methodological quality item for each included study. Key: green (+) = low risk of bias; yellow (?) = unclear risk of bias; red (‐) = high risk of bias.

2

Forest plot of comparison: 2 Ascorbic acid versus placebo, outcome: 2.1 Change in fatigue > 12 weeks after commencement of intervention at 12 months [VAS 0 ‐ 100).

3

Forest plot of comparison: 1 Ascorbic acid versus placebo, outcome: 1.2 Change in 10 m timed walk > 12 weeks after commencement of the intervention (measured at 12 to 24 months) [seconds].

4

Forest plot of comparison: 2 Ascorbic acid versus placebo, outcome: 2.4 Change in physical function score of SF‐36.

5

Forest plot of comparison: 2 Ascorbic acid versus placebo, outcome: 2.6 Adverse events.

1.1. Analysis

Comparison 1 Ascorbic acid versus placebo, Outcome 1 Change in fatigue > 12 weeks after commencement of intervention (measured at 12 to 24 months) (VAS 0 ‐ 10 or 0 ‐ 100).

1.2. Analysis

Comparison 1 Ascorbic acid versus placebo, Outcome 2 Change in 10 m timed walk > 12 weeks after commencement of the intervention (measured at 12 to 24 months).

1.3. Analysis

Comparison 1 Ascorbic acid versus placebo, Outcome 3 Change in speed of completion of 9 hole peg test > 12 weeks after commencement of intervention (measured at 24 months).

1.4. Analysis

Comparison 1 Ascorbic acid versus placebo, Outcome 4 Change in physical function score of SF‐36 > 12 weeks after commencement of the intervention (measured at 12 to 24 months).

1.5. Analysis

Comparison 1 Ascorbic acid versus placebo, Outcome 5 Change in mental function score of SF‐36 > 12 weeks after commencement of the intervention (measured at 12 months).

1.6. Analysis

Comparison 1 Ascorbic acid versus placebo, Outcome 6 Serious adverse events.