Pain from diabetic neuropathy is treated with specific anti-seizure medications and antidepressants rather than ordinary painkillers. Glucose control is what slows progression, and it is worth checking vitamin B12 given metformin's effect on it. Ordinary painkillers work poorly for this type of pain, which surprises people and is worth knowing before months are spent on them.
Pain from diabetic neuropathy is treated with specific anti-seizure medications and antidepressants rather than ordinary painkillers. Glucose control is what slows progression, and it is worth checking vitamin B12 given metformin's effect on it. Ordinary painkillers work poorly for this type of pain, which surprises people and is worth knowing before months are spent on them.
Improving glucose control slows progression of the neuropathy, which no pain medication does. It rarely reverses established damage, and being honest about that avoids disappointment, but it remains the intervention with the most influence on the trajectory. That makes diabetes management part of the neuropathy treatment rather than a separate matter, which is worth understanding in those terms rather than as general health advice.
Pregabalin and gabapentin, and duloxetine, are among the agents most used for painful diabetic neuropathy, with tricyclics such as amitriptyline also established. Each is started at a low dose and increased gradually. Topical lidocaine or capsaicin suit localised areas. Response differs between individuals so more than one trial is normal, and each needs an adequate dose for an adequate period before being called a failure.
Metformin lowers vitamin B12, and B12 deficiency causes neuropathy in its own right, so assuming diabetes explains everything can mean missing a treatable contributor. Ask for it to be checked. On cautions: gabapentinoids need dose adjustment in kidney impairment, which is common in diabetes, and cause drowsiness and unsteadiness that add to falls risk where sensation is already reduced. Duloxetine can affect blood pressure and glucose readings.
Clinical Neurology Specialists has been physician-owned since 1998, when Leo Germin, M.D., FAANEM founded it. Five board-certified neurologists and four advanced practice providers see patients at the Las Vegas and Henderson offices, each with its own AANEM-accredited electrodiagnostic laboratory.
Clinical Neurology Specialists is an adult outpatient neurology practice for patients 18 and older. The practice performs no surgery and operates no imaging suite, infusion suite or interventional pain programme, and provides no emergency or inpatient care.
Physician-reviewed. Reviewed by the physicians of Clinical Neurology Specialists — board-certified neurologists, AANEM-accredited electrodiagnostic laboratories, physician-owned since 1998. Reviewed 1 August 2026. This article is general education for adults 18 and older and is not a substitute for a consultation.
Sources and further reading: MedlinePlus: peripheral nerve disorders; MedlinePlus: EMG and nerve conduction studies; MedlinePlus, National Library of Medicine.
Adults 18 and older, at the Las Vegas and Henderson offices. Call 702-804-1212 or request an appointment online.