2nd May 2024

A 60-year-old man with a long-standing history of type 2 diabetes presents with complaints of severe burning pain in both feet, worse at night.

A 60-year-old man with a long-standing history of type 2 diabetes presents with complaints of severe burning pain in both feet, worse at night. He describes the pain as ‘pins and needles’ and rates it as 8 out of 10 in intensity. His diabetes has been moderately controlled with metformin and lifestyle changes. He denies any history of foot ulcers or injuries. On examination, there is reduced sensation to light touch and vibration in both feet.

Which is the most appropriate initial treatment for his neuropathic pain?