A 55-year-old man presents to the emergency room with severe pain in his lower limbs. The pain began the day previously, is burning in quality and radiates upwards into his thighs. The pain has been particularly severe at night. In the 3 months prior to this episode, he has been experiencing numbness in his toes and over the soles of his feet. He has a 12-year history of type II diabetes mellitus, hypercholesterolemia, hypertension, and had a myocardial infarction 2 years ago. His current medications include glyburide, metformin, insulin, simvastatin, atenolol, ramipril, and aspirin. On examination, there is a reduced vibration-perception threshold and reduced sensation using a 10-g monofilament over the dorsum of the foot and over the anterior lower limbs. There is also decreased pinprick sensation over the foot. Small muscle wasting of the feet is also evident. Proprioception, reflexes, muscle strength, and cranial nerves are intact. A random hemoglobin A1c is 13%. What is the most appropriate initial pharmacotherapy? A. Amitriptyline B. Mexiletine C. Oxycodone D. Pain clinic referral E. Tramadol
Posted on: Thu, 04 Jul 2013 12:42:10 +0000
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