24th February 2025

A 57-year-old woman with long-standing type 1 diabetes mellitus, depression, gastro-oesophageal reflux, and OA presents for a routine diabetic health check.

A 57-year-old woman with long-standing type 1 diabetes mellitus, depression, gastro-oesophageal reflux, and OA presents for a routine diabetic health check. Glycaemic control is suboptimal on a basal-bolus insulin regimen. Monofilament examination of the feet highlights peripheral neuropathy, though reassuringly, there are no current concerns about foot ulcers or Charcot arthropathy. Previous ankle X-rays have suggested that there are early degenerative changes in keeping with OA, and her pain there is described as a burning sensation. She currently takes paracetamol PRN for this and has been told previously to be careful with NSAIDs. What is the next step in pain management for this patient?

Select the SINGLE most appropriate option from the list below. Select ONE option only.