American Board of Internal Medicine (ABIM) Certification Practice Exam

In the treatment of painful diabetic neuropathy, which of the following is NOT typically considered?

1. Topical capsaicin

2. Anticonvulsants such as gabapentin

3. Tricyclic antidepressants

4. Beta-blockers

The correct answer is: Beta-blockers

In the management of painful diabetic neuropathy, treatments aim to relieve pain and improve quality of life. Topical capsaicin, anticonvulsants like gabapentin, and tricyclic antidepressants are all commonly employed therapeutic options for this condition due to their efficacy in neuropathic pain management. Topical capsaicin works by depleting substance P, a neuropeptide associated with pain transmission, thereby helping to alleviate localized pain when used consistently. Anticonvulsants such as gabapentin are effective in stabilizing neuronal membranes and modulating neurotransmitter release, which aids in reducing neuropathic pain. Tricyclic antidepressants also demonstrate benefit through serotonin and norepinephrine reuptake inhibition, which can help modulate pain pathways. In contrast, beta-blockers are primarily utilized for managing cardiovascular conditions, such as hypertension and arrhythmias, but they do not have a role in directly managing neuropathic pain. Their mechanism of action is not geared towards alleviating neuropathic pain and, therefore, is not typically considered in the treatment of painful diabetic neuropathy. This makes beta-blockers the least relevant option among the treatments listed for addressing the specific symptoms and physiology associated with neuropathic pain.