Treatment of Painful Diabetic Polyneuropathy

Patient Guidance

Publication Date: December 27, 2021
Last Updated: April 11, 2022



  • This patient guideline summarizes key takeaways from the current American Academy of Neurology (AAN) guidelines for painful diabetic neuropathy.
  • This pocket guide is meant to be used by both patients and their providers to ensure all parties are on the same page throughout the care process.

Painful diabetic neuropathy is common.

  • If you have diabetes, you should discuss nerve pain with your doctor.
  • While painful diabetic neuropathy can have a negative effect on your physical and mental health, there are a number of effective treatment options available to reduce painful diabetic neuropathy.
  • After starting treatment, from time to time, your doctor should check you for pain relief and side effects
  • Opioids should NOT be among the drugs you and your doctor consider for painful diabetic neuropathy because of the high risks of side effects. There are a number of safe and effective nonopioid medications available to help manage your pain.
  • If you are currently taking opioids for pain, you should talk with your health care team about a safe strategy for tapering off and eventually discontinuing use.



The first step towards your individualized care plan is an initial assessment with your health care team.

The purpose of the initial assessment is for your health care team to gain a better understanding of the types, frequency, and severity of your nerve pain and hear from you how it may be affecting your life.

Your health care team will regularly assess the frequency and severity of your pain during follow-up visits as well. This is how they gain a better understanding of what therapies are or are not working for you.

During the assessment, you may also be asked questions about your health history and any other medical conditions you may be experiencing. The presence of co-occurring conditions, which is common in patients with diabetes, may influence future treatment decisions.

Some patients with painful diabetic neuropathy may also experience issues with sleep as well as mental stress or depression. It is important to tell your health care team about these issues so that they can also be addressed.



The goal of treatment is to reduce the frequency and severity of your pain and improve your overall quality of life.

Decision-making about treatment should be a joint effort between you and your health care team after discussing all available options.

  • Your health care team will discuss all available treatment options with you. These options include both prescription medications and over the counter medications as well as nonpharmacologic approaches such as meditation and behavioral therapy.
  • Some patients might prefer to begin therapy with nonpharmacologic approaches, while others prefer to begin with prescription medications.
  • Should you choose a pharmacologic approach, there are medications that can be taken orally (e.g., pills/capsules) or medications that can be applied directly to your skin in the areas you are experiencing pain (e.g., topicals/creams) (see Table 1).

Table 1. Recommended Treatment Options for Painful Diabetic Neuropathy

Having trouble viewing table?
Medication Class Generic / Brand
Topical Medications
Capsaicin (Prescription) Capsaicin / Qutenza
Capsaicin (Over the Counter) Capsaicin / many
Oral Medications
Serotonin-norepinephrine reuptake inhibitor (SNRIs) Duloxetine / Cymbalta
Venlafaxine / Effexor
Desvenlafaxine / Pristiq, Khedezia
Gabapentinoids Gabapentin / Neurontin
Pregabalin / Lyrica
Sodium channel antagonist Oxcarbazepine / Oxtellar
Lamotrigine / Lamictal
Lacosamide / Vimpat
Tricyclic antidepressants (TCAs) Amitriptyline / Elavil, others
Nontraditional and Nonpharmacologic
Cognitive behavioral therapy (CBT)
Tai Chi

Switching Therapies

Switching Therapies


  • Throughout the care process, remember that every patient is different.
    • Not all medications work the same way for each person. You may need to try more than one medication in order to find the treatment that works best for you.
    • Patience will be necessary throughout this process. You may need to try a medication for up to 12 months to know whether it works for you. The goal is to find a medication that gives you the most pain relief with the fewest negative effects.
  • It’s important to talk to your health care team if you are experiencing any side effects from your medications. If the side effects outweigh the benefits, you may need to try another medication.

Shared Decision Making

Shared Decision Making


  • All treatment plans should be tailored around your specific goals and preferences.
  • When designing your treatment plan with your health care team, you should consider various factors such as:
    • your preference for pharmacologic or nonpharmacologic approaches
    • treatment costs and insurance coverage
    • potential for side effects
    • other conditions you have and how the treatment may interact with any other medications you are taking
    • ease of use and convenience of treatment
There is no right or wrong choice when it comes to finding the right approach to managing painful diabetic neuropathy — it’s all about finding the treatment that is right for you.

Patient FAQ

Patient FAQ

Q: What are symptoms of painful diabetic neuropathy?

A: Symptoms of painful diabetic neuropathy include:
  • numbness or tingling in your feet
  • prickly, sharp and/or burning pain in your feet or legs
  • muscle weakness
  • loss of balance
  • swelling or changes in the shape of your foot
  • dry, cracking skin
Talk to your doctor if you are experiencing one or more of these symptoms.

Q: Are there tests to diagnose painful diabetic neuropathy?

A: The most common way to diagnose painful diabetic neuropathy is a comprehensive foot exam, a physical exam, and a detailed review of your medical history. Some patients will also undergo additional blood and neurologic tests. These are usually done to rule out other potential conditions.

Q: How often should I be examined for painful diabetic neuropathy?

A: If you have diabetes, you should get a thorough exam at least once a year. During this exam, your health care team should look at your feet for signs of problems and check the blood flow and feeling, or sensation, in your feet.

Q: Is there a cure for painful diabetic neuropathy?

A: Unfortunately, no — there is no cure. It is important to understand that therapy may not completely eliminate the pain you feel. The goal of treatment is to decrease pain to help improve your overall quality of life.