Pharmacological Treatment by drug name.

The classes of drugs with the best proven efficacy are anti-   depressants, anticonvulsants, and opioids.

Antidepressants

Cymbalta is only available as brand name (the chemical name is duloxetine )

    All doses of duloxetine were well tolerated, with no sig- nificant changes in concentrations of A1C, LDL-C, HDL-C, or triglycerides.54 Adverse events included somnolence and constipation with the 60-mg/day dose, and nausea, somno- lence, dizziness, constipation, dry mouth, sweating, decreased appetite, anorexia, and weakness with the 120-mg/day dose.

    Venlafaxine is generic for Effexor

has yielded efficacy in alleviating pain in diabetic neuropathy when used in higher doses (150-225 mg/day)

Tricyclic Antidepressants

    Tricyclic antidepressants (TCAs) are widely used to treat neuropathic pain but are not FDA-approved for this purpose and have a significant adverse-effect profile.58

   amitriptyline ---is generic for Elavil

   desipramine ----is generic for Norpramin

   clomipramine---is generic for Anafranil

   nortriptyline-----is generic for Pamelor

Anticonvulsants

     Lyrica is brand name for pregabalin.  It is FDA-approved for painful diabetic neuropathy

Anesthetics

Lidocaine Patches

    Lidocaine patches may be useful if the pain of diabetic neu- ropathy is very focal. One to 3 patches can be applied to intact skin over the painful area, 12 hours on and 12 hours off.

Natural products

Capsaicin Cream

    Capsaicin cream depletes substance P, the major neuro- transmitter used in conveying messages about pain into the central nervous system.

Education and Effective Patient-Clinician Communication Is Critical for Treatment Success