Sorry to hear this; the thread above is interesting and helpful.
Firstly, I would just check that there is not anything else contributing to neuropathy such as low vitamin B12, low vitamin D, underactive thyroid, monoclonal gammopathy (check a serum electrophoresis), calcium and LFTs (sorry - medical hat on); and no excess alcohol.
No one is totally sure about the vitamin D, but if your calcium level is Ok, I would aim for a level of about 70 (my level was 15) by taking vitamin D3 Fultium. It might help the neuropathy, but won't harm you.
One would also try and address any underlying depression, although one could truthfully say that sorting the pain might sort the depression, but depression and diabetes go hand in hand both ways.
After that, it is trying the different drugs. 20 years ago, I thought that they worked really well, but now when we have more drugs, I am less convinced.
I think the thread above is really good (I would never be patronising) because it shows the real life experience of using the drugs.
One would look at the individual person to decide which agent to try, but my order would generally be:-
1: Duloxetine - this can work really well, but go up the dose gently and take with food in evening cos its common side effects are sleepyness (actually, most of the drugs have this problem) and nausea. There are other antidepressants such as amitriptyline that can be used instead
2: Anti-epileptic tablets such as gabapentin and pregabalin. Again these make folk sleepy. Pregabalin is easier to escalate the doses, but there is not a great deal between them; both made by Pfizer, so there is not going to be a comparative trial. Otehrs such as tegeretol and its related drug whose name escapes me and phenytoin can be used, but the gabapentin/pregabalin seem better.
3: Strong pain killers such as oxycodone, buprenorphine, morphine and tramadol (horrible drug) are all used and are sometimes effective.
4: Capsaicin patch / cream are fiddly; one needs to be very gentle with the dose else it burns (so don't rub eyes after applying), but in some folk it is handy
At the end of the day, it is a case of trying different things with some pain scales before and after to see effect; sometimes, one stops a drug cos it does not seem to be helping, but then the pain is worse afterwards, so keep an open mind.
Often have two drugs on top of the vitamin D, and bed cradle to keep feet OK at night - lots of folk keep a cold metal tray by bed to stand on when feet burn at night - seems effective.
IMHO, one can generally make pain bearable, but not get rid of it - sorry; and it needs a fair bit of medical input to sort. Not sure if pain clinics can help, cos they are snowed under. I would have thought that a diabetologist would be as good or better than a neurologist at addressing this problem.
Hope this helps; I have neuropathic pain from B12 deficiency and Vt D deficiency so it is improving on the vitamins (have to give my own IM B12 injections - not a prob - beats having to go to GP); I stopped my duloxetine for this and significant depression cos of the side effects. have to see how I do. best wishes
