Prescribing for Painful Diabetic Peripheral Neuropathy

Patient B-217, a 62-year-old woman, presents with a 6-month history of burning pain in both feet, worse at night and interfering with sleep. She describes numbness and tingling. She has type 2 diabetes for 10 years. Her other medical history includes hypertension and hypercholesterolaemia. Current medicines: metformin 1000 mg twice daily, lisinopril 10 mg daily, atorvastatin 20 mg daily. She has no known drug allergies. She is not pregnant. On examination: weight 72 kg, blood pressure 145/80 mmHg. Both feet have reduced vibration sense and abnormal monofilament testing; dorsalis pedis pulses are present. Investigations: HbA1c 74 mmol/mol (8.9%), serum creatinine 1.1 mg/dL with eGFR 50 mL/min/1.73 m2, liver function tests normal. Her pain is having a significant impact on her sleep and daily activities. She lives alone and drives a car. Prescribe an appropriate medication for her neuropathic pain, including starting dose and titration. Provide advice on driving and sedation.