Modality Choice Before and After Failure for the Treatment of Painful Diabetic Neuropathy

The research team will perform a comparative‐effectiveness sequential, multipleassignment, randomized trial in painful diabetic neuropathy (PDN) patients for 8 totalmonths, divided into two 4‐month stages. 600 participants 18+ with PDN will be enrolledin this study. The main goal is to compare the utility of three modalities (oral,topical, and behavioral) for initial PDN treatment, and to compare the utility ofswitching modalities versus continuing with the same modality for non‐responders. Painand discontinuation will be assessed weekly, whereas other outcomes will be assessedmonthly for 8 months.