Diabetic Neuropathy

Key points

• Diabetic neuropathy Diabetes typically leads to sensory loss and not motor loss in peripheral neuropathy. Painful diabetic neuropathy is a common problem in clinical practice.
• 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)