A 50-year-old woman comes to the physician because of a 5-month history of progressive numbness of her lower legs. She reports having difficulties sleeping because of a tingling sensation in her feet that keeps her awake. The symptoms began in the toes of both feet and have since progressed to her ankles and calves bilaterally. She was diagnosed with diabetes mellitus 8 years ago and hypertension 3 years ago. The patient quit smoking 8 years ago and does not use alcohol. Blood pressure is 126/70 mm Hg and pulse is 68/min. Lower extremity examination shows normal-appearing skin. Touching the feet elicits a sensation of burning pain. There is loss of vibration sensation in the toes, and the ankle reflex is absent bilaterally. Which of the following is the best initial pharmacotherapy for this patient's symptoms?

Question

A 50-year-old woman comes to the physician because of a 5-month history of progressive numbness of her lower legs. She reports having difficulties sleeping because of a tingling sensation in her feet that keeps her awake. The symptoms began in the toes of both feet and have since progressed to her ankles and calves bilaterally. She was diagnosed with diabetes mellitus 8 years ago and hypertension 3 years ago.  The patient quit smoking 8 years ago and does not use alcohol.  Blood pressure is 126/70 mm Hg and pulse is 68/min.  Lower extremity examination shows normal-appearing skin.  Touching the feet elicits a sensation of burning pain.  There is loss of vibration sensation in the toes, and the ankle reflex is absent bilaterally.  Which of the following is the best initial pharmacotherapy for this patient's symptoms?

Quizplus · Accepted Answer

Eductional Objective: Patients with long-standing, poorly controlled diabetes mellitus are at high risk for developing distal symmetric polyneuropathy (diabetic neuropathy).  Symptoms generally include progressive numbness, tingling, and burning/stabbing pain in the feet and/or toes that progresses proximally.  Painful neuropathy is treated with serotonin-norepinephrine reuptake inhibitors, gabapentinoids, or tricyclic antidepressants.

A 50-Year-Old Woman Comes to the Physician Because of a 5-Month