A 55 year old female presented with tingling sensation in her hands and feet & pain in her legs during night time. She had type 2 diabetes for 15 years. O/E- loss of ankle deep tendon reflex, loss of position sense of great toe, decreased pinprick sensation over ankles & wrists. Her recent HbA1c was 8.9%. She is currently managed with insulin and metformin. She is diagnosed with diabetic polyneuropathy. Which of the following medications can be used to treat pain associated with diabetic neuropathy?

Diabetic neuropathy can manifests as polyneuropathy, mononeuropathy, and/or autonomic neuropathy. The most common form is distal symmetric polyneuropathy- presents as distal sensory loss and pain. Management: Improved glycemic control Neurotoxins (alcohol, smoking, and vitamin deficiencies) should be avoided. Only two agents--duloxetine and pregabalin--have been approved by the U.S. FDA for the treatment of diabetic neuropathy. Other off-label agents- amitriptyline, gabapentin, valproate, and opioids.