A diabetic man is diagnosed as having painful diabetic neuropathy in his feet. He has no other medical history of note. What is the most suitable first-line treatment to relieve his pain?
A. Duloxetine
B. Sodium valproate
C. Carbamazepine
D. Referral to pain management clinic
E. Tramadol
Answer:
A. Duloxetine
Discussion:
NICE updated it's guidance on the management of neuropathic pain in 2013.
Diabetic neuropathy is now managed in the same way as other forms of neuropathic pain:
first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
if the first-line drug treatment does not work try one of the other 3 drugs
tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
pain management clinics may be useful in patients with resistant problems
Gastroparesis : symptoms include erratic blood glucose control, bloating and vomiting
management options include metoclopramide, domperidone or erythromycin (prokinetic agents)
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