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PAINFUL DIABETIC NEUROPATHY MANAGEMENT

Confirm . Improve metabolic control Explanation, empathy Set realistic targets. Insidious onset. Acute onset. Gabapentin 300mg bd-2 days 300mg tds – 2 days CT 600mg tds. Mild, no sleep disturbance. Moderate/severe sleep disturbance. Gabapentin 100-300mg od increasing as necessary

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PAINFUL DIABETIC NEUROPATHY MANAGEMENT

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  1. Confirm  • Improve metabolic control • Explanation, empathy • Set realistic targets Insidious onset Acute onset Gabapentin 300mg bd-2 days 300mg tds – 2 days CT 600mg tds Mild, no sleep disturbance Moderate/severe sleep disturbance Gabapentin 100-300mg od increasing as necessary Topical Rx Opsite Capsaicin Amitriptyline 10mg Titrate dose over 2-4/52 Max 100mg od SE SE Poor sleep Persistent pain after 4/52 max tolerated dose Add Amitriptyline 10mg Add Gabapentin Still symptoms Pregabalin GTN Spray Lignocaine Patches Consider referral to Acupuncture (Judith Aarons) Try Pregabalin Try GTN Spray Lignocaine Patches Try Pregabalin Try GTNSpray Lignocaine Patches Add Tramadol if breakthrough pain Add Tramadol if breakthrough pain Persistent pain 4-8/52 Max tolerated therapy Pain Clinic referral or admission Lignocaine infusion Acupuncture Persistent pain 4-8/52 Max tolerated therapy PAINFUL DIABETIC NEUROPATHY MANAGEMENT

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