First-line medicines and foot care have the strongest evidence for neuropathy symptoms. Capsaicin helps localised pain. PRP has one small positive trial in diabetic neuropathy. Stem cells are early research.
| Treatment | Evidence | Guideline position |
|---|---|---|
| Duloxetine | Strong | NICE first line; ADA first line; ASCO for CIPN |
| Pregabalin / gabapentin | Strong | NICE first line; ADA first line |
| Amitriptyline | Moderate | NICE first line |
| Capsaicin cream / patch | Moderate | NICE: localised pain |
| Glucose control | Strong (prevention) | ADA |
| Exercise, foot care | Good | Recommended |
| Perineural PRP | One small RCT | Not in guidelines |
| Stem cells | Early research | Not in guidelines |
Sources on our sources page.