A 60-year-old woman with diabetes reports burning pain in both feet at night. Examination shows decreased vibration and pinprick in a stocking

Question

A 60-year-old woman with diabetes reports burning pain in both feet at night. Examination shows decreased vibration and pinprick in a stocking distribution. B12 and TSH are normal and pedal pulses are intact. Which of the following is the most appropriate next step in management?

Accepted Answer

Start duloxetine or pregabalin for neuropathic pain

Answer

Schedule lumbar laminectomy without imaging

Answer

Start high-dose opioids as initial therapy

Answer

Use systemic steroids for neuropathy

Answer

Treat with chronic antibiotics

Diabetic neuropathy — USMLE Step 3 MCQ

A 60-year-old woman with diabetes reports burning pain in both feet at night. Examination shows decreased vibration and pinprick in a stocking distribution. B12 and TSH are normal and pedal pulses are intact. Which of the following is the most appropriate next step in management?