In March, I shared a case of a woman with diabetes-related peripheral neuropathy to highlight issues of pain management in primary care. To recap: Maria, age 68, had been experiencing burning pain sensations in her feet and ankles for the past 3 years. I decided to prescribe duloxetine, and I asked for and received feedback from readers about my management of this patient.
I appreciate the variety of comments on Maria's case! It was interesting to read the mix of experiences with treating patients who have peripheral diabetic neuropathy (PDN) as well as the personal experiences overcoming neuropathy. This mix of experiences is a major factor in how we all practice healthcare.
However, some of those who commented felt that I could have offered a couple of other treatments for Maria's painful condition.
What About Topical Lidocaine?
Readers strongly supported the use of topical lidocaine for Maria. I have found that many patients prefer topical lidocaine for a variety of pain conditions, but its efficacy is largely yet to be established in high-quality clinical trials. A systematic reviewof randomized, double-blind studies of topical lidocaine for neuropathic pain found 12 studies with a total of only 508 participants. All studies were judged to be at high risk for bias; however, the collective result suggested that topical lidocaine was superior to placebo.
