American Board of Internal Medicine (ABIM) Certification Practice Exam

Which medications are FDA approved for the treatment of painful diabetic neuropathy?

1. Tricyclic antidepressants

2. Gabapentin and palmitoylethanolamide

3. Pregabalin, duloxetine, and tapentadol

4. SSRIs and SNRIs

The correct answer is: Pregabalin, duloxetine, and tapentadol

The correct answer includes pregabalin, duloxetine, and tapentadol, all of which have FDA approval for the treatment of painful diabetic neuropathy. Pregabalin is an anticonvulsant that works by modulating calcium channel activity, which reduces the release of excitatory neurotransmitters, thus helping to alleviate neuropathic pain. Duloxetine, a serotonin-norepinephrine reuptake inhibitor (SNRI), is effective in managing chronic pain, including neuropathic pain, due to its ability to enhance the levels of neurotransmitters that help in pain modulation. Tapentadol is a combination of μ-opioid receptor agonism and norepinephrine reuptake inhibition, providing a dual mechanism to target pain pathways effectively. Other options listed may be used in the management of neuropathic pain but lack specific FDA approval for this indication. For instance, while tricyclic antidepressants can be effective for neuropathic pain, they are not exclusively FDA-approved for painful diabetic neuropathy. Gabapentin is often used, but palmitoylethanolamide is not an FDA-approved treatment in this context. SSRIs and SNRIs other than duloxetine may help with emotional symptoms associated with diabetic neuropathy but do