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Painful diabetic neuropathy — SCE Endocrinology MCQ

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EasyDiabetesPainful diabetic neuropathySCE Endocrinology

A 56-year-old man with type 2 diabetes has burning pain in both feet that wakes him at night. Examination shows stocking sensory loss, intact pulses and no ulceration. eGFR is 78 ml/min/1.73 m² and HbA1c is 55 mmol/mol. What is the most appropriate management?

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Correct answer: C — Start duloxetine or amitriptyline for painful neuropathy

Symmetrical painful diabetic neuropathy is managed with neuropathic pain agents such as duloxetine or amitriptyline, alongside foot protection and risk-factor review. Long-term opioids are not preferred first-line therapy. The pearl is that pain severity can be high even when ulcer risk examination is otherwise stable.

Reference: NICE neuropathic pain guideline CG173, NICE NG28