Rigid Glucose Control	DCCT Study
Tricyclic Antidepressants	Amitriptyline Nortriptyline Imipramine Desiprimine Trazodone	These work by blocking the neurotransmitter system norepinephrine and serotonin respsible, for pain modulation.
Phenothiazines	Fluphenazine Perphenazine Triavil	Used to augment the tricyclic antidepressants. Rarely use by themselves. They are known to cause tardive dyskinesia.
Anticonvulsants	Carbamazepine	Not a first line drug. Because of a significant risk of hepatitis and pancytopenia, liver function tests and a complete blood count should be performed every 3 months. Need to be progressively dosed.
Muscle Relaxants	Baclofen Metaxalone	It is appropriate to use muscle relaxants when the muscular type of pain is present with cramping of grabbing sensations.
Hemorrheologic Agents	Pentoxifylline (trentol)	Its effects alter the viscosity and flow of blood. These effects include increased red and white cell deformability, reduced plasma viscosity, decreased plasma fibrinogen concentrations, and reduced platlet and red cell aggregation.
Aldose Reductase Inhibitors	Sorbinil	Will partially reverse some of the damage done to the nerve by heperglycimia.
Topical Irritants	Zostrix	Will deplete substance P from the terminals and central connections of the C-type fibers. It is effective in treating the superficial component only. It is a good adjunctive therapy when used in combination with oral modalities.

Topical treatment of Neuropathy:
Capsaicin comes under the trade name Zostrix and is the only effective topical counterirritant on the market. Endogenous neurotransmitters, especially substance P, are important mediators of nociception in the peripheral nervous system. Capsaicin is known to deplete substance P from the terminals and central connections of the C-type fibers. It is effective in treating the superficial component only. Capsaicin may be less effective when used by itself because of the multifaceted nature of peripheral neuropathy. However, it is a good adjunctive therapy when used in combination with oral modalities.

Vitamin treatment of Neuropathy:
Deficiencies of thiamine, pyrodoxine, and cobalamin each result in burning pain and peripheral neuropathy. It has been assumed, therefore, that vitamin supplements would improve the symptoms of any neuropathy, regardless of the cause. Each of the above vitamins has been tried to ameliorate the symptoms of diabetic neuropathy.

There has been no evidence that thiamine deficiency was a factor in the etiology of diabetic neuropathy. Several controlled studies have failed to show any greater relief with pyridoxine than with placebo.

Because of the lack of evidence of clinical efficacy, vitamins cannot be recommended as an effective treatment for painful diabetic peripheral neuropathy.