Clinical Case Database / Category: Clinical Care

Painful neuropathy

Publication details

Dr Jonathan A. Knibb MA(Oxon.), MRCP, Dr Tahir Majeed PhD, FACP, FRCPI, FRCP
Foundation Years Journal, volume 4, issue 3, p.23 (123Doc Education, London, March 2010)


The case of an elderly diabetic man with gradually progressive bilateral foot pain is presented. The pain was burning in character, worse at rest and associated with absent ankle jerks and symmetrical reduction of pinprick sensation in a stocking distribution. After investigations to rule out alternative causes, a diagnosis of painful diabetic axonal polyneuropathy was made. He did not tolerate gabapentin, but amitriptyline was successful in reducing the intensity of his pain.

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Dr Jonathan A. Knibb MA(Oxon.), MRCP

Royal Preston Hospital
Sharoe Green Lane North
Preston PR2 9HT

Dr Tahir Majeed PhD, FACP, FRCPI, FRCP

Royal Preston Hospital
Sharoe Green Lane North
Preston PR2 9HT


1. Smith AG, Russell J, Feldman EL, Goldstein J, Peltier A, Smith S, et al. (2006) Lifestyle intervention for pre-diabetic neuropathy. Diabetes Care, June, 29(6):1294–1299.
2. Freynhagen R, Bennett MI (2009) Diagnosis and management of neuropathic pain. BMJ, 339:b3002.


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T​he Foundation Years Clinical Cases Database is​ a selection of 600 peer-reviewed clinical cases in the field of patient safety and clinical practice, specifically focused on the clinical information needs of junior doctors, based around the Foundation Year Curriculum programme (MMC). The cases have been chosen to align with the Foundation Year Curriculum.

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