Brief Answer: Insulin injections. Antidepressents, Strict diet. Detailed Answer: Hello, I have gone through your query and understand your concern. Before you deal the pain, it is important to keep your blood sugar in normal limits. I prefer to use insulin than oral hypoglycemic agents in patients with severe neuropathy. What is your recent blood sugar value - Fasting and Prostprandial blood sugar and HbA1C level. If they are no in limits, it would be better to start insulin. Now for pain, I see you are on lyrica and pain control medications. If they are not effective, it can be switched to tricyclic antidepressants like amitriptyline. Dose can be adjusted to suit your needs. Besides medication, foot care is going to be important. 1. Clean your feet daily, using warm-not hot-water and a mild soap. Avoid soaking your feet. Dry them with a soft towel and dry carefully between your toes. 2. Inspect your feet and toes every day for cuts, blisters, redness, swelling, calluses, or other problems. Use a mirror-laying a mirror on the floor works well-or get help from someone else if you cannot see the bottoms of your feet. 3. Wear shoes that fit well and allow your toes to move. Break in new shoes gradually by first wearing them for only an hour at a time. 4. Before putting your shoes on, look them over carefully and feel the insides with your hand to make sure they have no tears, sharp edges, or objects in them that might injure your feet. Hope this helps. please write back for further queries. Wishing you good health.

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