Diabetic neuropathy

NICE updated it's guidance on the management of neuropathic pain in 2013. Diabetic neuropathy is now managed in the same way as other forms of neuropathic pain:

• first-line treatment: amitriptyline, duloxetine, gabapentin or pregabalin
• if the first-line drug treatment does not work try one of the other 3 drugs
• tramadol may be used as 'rescue therapy' for exacerbations of neuropathic pain
• topical capsaicin may be used for localised neuropathic pain (e.g. post-herpetic neuralgia)
• pain management clinics may be useful in patients with resistant problems

Gastroparesis

• symptoms include erratic blood glucose control, bloating and vomiting
• management options include metoclopramide, domperidone or erythromycin (prokinetic agents)