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A 58-year-old company manager with a six-year history of type 2 diabetes complained of a persistent, sharp stabbing pain in his feet. His symptoms are worse at night and often made worse by light pressure—for example by a blanket—over his feet. On examination, he has easily palpable foot pulses and peripheral neuropathy manifesting as loss of pinprick and vibration sensation up to his ankles.

Describe the pathophysiology and clinical features of painful neuropathy. How would you attempt to relieve his symptoms?

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