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Gabapentin for Painful Diabetic Neuropathy
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To the Editor: Our concerns regarding the article by Dr Backonja and colleagues1 on gabapentin for treatment of painful diabetic neuropathy are related to how data on patient interpretation and recording of pain are statistically analyzed, as well as how clinical rather than statistical significance of improvement on pain scores is determined.
We appreciate the difficulties in performing pain research and the complexities inherent in the analysis of health-related quality-of-life questionnaires. The primary outcome measure (Likert Pain Scale), however, is essentially categorical data and yet is analyzed as if it were numerical. The scale uses numbers that correlate with the severity of pain but could just as well have used letters from A-K. In other words, the numbers stand for categories of pain, and the distance between them cannot be assumed to be uniform. To treat these numbers as statistically or mathematically meaningful is incorrect. Just as we would not . . . [Full Text of this Article]
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