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For symptom management of neuropathic pain, the American Academy of Neurology and American Diabetes Association guidelines recommend: First-line: Duloxetine or pregabalin (with appropriate renal dose adjustments) Alternative options: Gabapentin (with renal dose adjustments) or tricyclic antidepressants (with caution in older adults and cardiac disease) Topical treatments: Capsaicin 8% patch or lidocaine 5% patch for localized symptoms Avoid chronic opioid therapy due to limited evidence and safety concerns Non-pharmacological approaches including physical therapy, proper foot care, and pain psychology techniques provide additional benefit