The treatment of painful diabetic distal polyneuropathy remains a daunting challenge to the physicians. Major problems in this area remain the paucity of large multicenter conclusive trials, the frequency of side-effects, and particularly the lack of controlled trials using comparator therapies rather than a placebo. Before embarking on a pharmacological therapy, the importance of a thorough history and examination together with an understanding approach, and a serious attempt to stabilize glycemic control cannot be overemphasized. Finally, it must be remembered that all patients with distal sensory polyneuropathy are at potential risk of foot ulceration and should receive preventative foot care education as outlined in Chapter 28 of this volume.

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