Vitamin B for treating peripheral neuropathy.
Level 1 - systematic review of randomized trials
Cochrane systematic review of randomized and quasi-randomized controlled trials
PubMed 18646107 · doi:10.1002/14651858.CD004573.pub3
What was done
A Cochrane systematic review evaluating randomized and quasi-randomized controlled trials that compared vitamin B with placebo or active comparators in patients with generalized peripheral neuropathy (specifically diabetic or alcoholic neuropathy). Searches were conducted through late 2005 across major databases and manufacturer contacts. Study quality assessment and data extraction were performed independently by two authors.
What was found
Thirteen studies with 741 total participants met inclusion criteria. When compared to placebo, two small trials found no significant short-term reduction in pain intensity, though one trial reported a small significant improvement in vibration detection threshold with oral benfotiamine. In trials comparing doses, the larger of two studies found higher doses of vitamin B complex led to significant short-term reductions in pain and paresthesias compared to lower doses. Small comparative trials suggested vitamin B was less efficacious than alpha-lipoic acid, cilostazol, or cytidine triphosphate for short-term clinical and nerve conduction endpoints. Adverse effects were minor and infrequent. The abstract reported no specific numerical point estimates or confidence intervals.
Why it matters
Despite frequent clinical prescription of vitamin B for neuropathy, trial evidence remains too sparse and underpowered to confirm therapeutic efficacy over placebo or superiority to alternative treatments.
Limits
The evidence base is constrained by very small individual study sizes (averaging under 60 patients per trial), brief intervention durations (2 to 8 weeks), inclusion of quasi-randomized trial designs, and restriction to alcoholic and diabetic neuropathies.
Cited by
- partial Benfotiamine, typically taken with alpha-lipoic acid, treats burning feet and peripheral neuropathy.