Managing diabetic peripheral neuropathic pain in primary care

DPN is a common complication of T2DM that often causes a pain syndrome. The diagnosis of DPNP centers around a careful history and physical examination, aided by the use of diagnostic tools, such as the 128-Hz tuning fork. A reduction in pain severity of 30% to 50% is achievable for most patients but generally requires combination therapy. In addition to duloxetine and pregabalin, which have been approved by the FDA for DPNP, adjuvant analgesics are the mainstay of therapy. Of the adjuvant analgesics, the use of the tricyclic antidepressant and anticonvulsant groups is supported by the most extensive evidence. The selection of an adjuvant analgesic is often based on patient comorbidities and tolerability. Frequent follow-up is needed to optimize therapy.