Diabetic nerve pain visit, online

Common symptoms

• Burning, tingling, or stabbing pain in both feet
• Pain that has lasted 3 months or longer
• Nerve damage from diabetes that a clinician already found in person

May fit online care

• Adults 18 and older
• You are 25 to 64
• A doctor, nurse practitioner, or physician assistant found painful diabetic nerve damage in person, and examined your feet in person in the last 12 months
• Your pain is in both feet and has lasted 3 months or longer, and your clinician said it comes from your diabetes with no tests or nerve specialist still needed
• A doctor or clinic looks after your diabetes, and you saw them in the last 12 months
• Your last A1c was below 9, from the last 12 months, and you were not in the hospital or the ER for blood sugar in the last 3 months
• You have a blood pressure reading from the last 7 days that is below 140/90, and photos of the tops and bottoms of both feet
• You have none of the warning signs below

Look for another care setting

• Black or dead-looking skin on a foot or toe, or a foot sore that smells bad and is turning black (call 911 or go to the ER now).
• A foot or leg that is red, warm, or swollen, or has pus, together with a fever of 100.4°F (38°C) or higher in the last 24 hours, shaking chills, or feeling very sick (call 911 or go to the ER now).
• A foot or toe that suddenly turned cold, pale, or blue, or suddenly hurts or went numb and looks different from the other foot (call 911 or go to the ER now).
• A leg or foot that is newly weak, or weakness that is getting worse (call 911 or go to the ER now).
• Weakness on one side of your body, a drooping face, trouble speaking, or sudden loss of vision (call 911 or go to the ER now).
• New loss of control of your pee or poo, new trouble starting to pee, or not being able to pee (call 911 or go to the ER now).
• Numbness around your genitals, bottom (anus), or inner thighs (call 911 or go to the ER now).
• Chest pain, trouble breathing, or fainting (call 911 or go to the ER now).
• Very low blood sugar: you passed out, had a seizure, or are too confused or too sleepy to eat or drink (call 911 or go to the ER now).
• Very high blood sugar: you are vomiting and cannot keep fluids down, or you have confusion, rapid or deep breathing, or severe belly pain (call 911 or go to the ER now).
• After you start duloxetine: you took more duloxetine than your plan says, even a little more. Call 911 or go to the ER now.
• After you start duloxetine: trouble breathing or wheezing, hives, or swelling of your face, lips, tongue, or throat. Blisters, a peeling rash, or sores in your mouth. Vomiting blood, bloody, black, or tarry poo, or feeling faint. Stop the medicine. Call 911 or go to the ER now.
• After you start duloxetine: you feel very agitated. You see or hear things that are not there. You are confused, or your heart races. You sweat a lot with a fever. You shake, your muscles twitch or feel stiff, or you have a seizure. Stop the medicine. Call 911 or go to the ER now.
• After you start duloxetine: eye pain, a change in your vision, or swelling or redness in or around your eye. Stop the medicine. Call 911 or go to the ER now.
• Thoughts of ending your life, or of hurting yourself or someone else: call or text 988 now. Call 911 if you are in danger. After you start duloxetine, do the same if you are acting on dangerous impulses. Stop the medicine.
• The skin on your foot or leg is red, warm, or painful. Your foot or leg has new swelling you cannot explain. You see pus or a red streak going up your leg (go to the ER or urgent care today).
• Your foot is hot, red, and swollen, and you have no open sore, which can be Charcot foot (go to the ER or urgent care today).
• After you start duloxetine, you fell and were hurt in the last 24 hours (go to the ER or urgent care today).
• After you start duloxetine: your skin or eyes turn yellow. Your pee is dark. You itch, or you have pain in the upper right belly. Stop the medicine (go to the ER or urgent care today).
• After you start duloxetine: bleeding that will not stop. Large bruises you cannot explain. A bad headache with feeling weak, unsteady, or unable to think clearly. Stop the medicine (go to the ER or urgent care today).
• You have an open sore on your foot, a blister that broke, or a callus with dried blood inside. Or you stepped on something sharp in the last 7 days (see a doctor in person today).
• You have a cut, blister, or bruise on your foot that has not started to heal after a few days (see a doctor in person today).
• After you start duloxetine, any new skin rash. Stop the medicine (see a doctor in person today).
• After you start duloxetine: new or worse sadness, worry, or panic attacks. Feeling very agitated or restless. New anger or irritability. A burst of high energy with little need for sleep, or racing thoughts. Stop the medicine (see a doctor in person today).
• After you start duloxetine: you had thoughts of ending your life or harming yourself since you started. This counts even if they passed. Stop the medicine (see a doctor in person today).
• Your pain is different or much worse than when it was first found (see a doctor in person within 7 days).
• Your pain or numbness has spread up past your knees, or to your hands or belly (see a doctor in person within 7 days).
• Your foot has changed shape. Your calf, thigh, or buttock cramps when you walk. Or you have foot pain at rest that eases when your foot hangs down (see a doctor in person within 7 days).
• You take an MAOI (phenelzine, tranylcypromine, selegiline, rasagiline, isocarboxazid, or a brand such as Marplan, Nardil, Parnate, Azilect, or the Emsam patch) now or in the last 14 days. Or you take linezolid (Zyvox) or methylene blue now or in the last 24 hours. Or a doctor says you need one of these. Stop duloxetine now, if you have it. The doctor who prescribes that medicine decides what to do (see your own doctor).
• No doctor found painful diabetic nerve damage in person. Or no doctor examined your feet in person in the last 12 months (see your own doctor).
• The doctor did not say your nerve pain comes from diabetes, or is still checking for another cause (see your own doctor).
• The doctor said you need tests or a nerve specialist that you have not had yet (see your own doctor).
• Your pain has lasted less than 3 months (see your own doctor).
• The pain is in only one foot or leg, or it began in your hands, belly, or chest (see your own doctor).
• No doctor looks after your diabetes, or you did not see one in the last 12 months (see your own doctor).
• Your last A1c was 9 or higher, you had none in the last 12 months, or you do not know it (see your own doctor).
• You were in the hospital or the ER for very high or very low blood sugar in the last 3 months (see your own doctor).
• Your GFR is under 30, or you are on dialysis. Or you have kidney disease and your latest GFR is older than 12 months, or you do not know it (see your own doctor).
• You are under 25, or 65 or older (see your own doctor).
• When you ask for a medicine or at a check-in, you have no blood pressure reading from the last 7 days. Or your reading is 140/90 or higher (see your own doctor).
• You take any opioid for any reason, like tramadol, methadone, or buprenorphine. You take gabapentin, pregabalin, tapentadol, or a benzodiazepine for this pain now. Or you want a prescription for one of these (see your own doctor, the one who prescribes it).
• You have bipolar disorder or mania, in you or your family. You have thoughts of ending your life now or in the past. Or you had a suicide attempt in the past (see your own doctor).
• You have liver disease, cirrhosis, or fatty liver, or 3 or more alcoholic drinks a day (see your own doctor).
• You have high blood pressure that is not well controlled. You had a heart attack lately. Or you have heart disease that is not stable (see your own doctor).
• You have seizures. You have glaucoma or narrow eye angles. Or you have low sodium in your blood, or you take a water pill (see your own doctor).
• You have trouble starting to pee, or a bladder that does not empty well. You have an enlarged prostate. Or you have a stomach that empties slowly (see your own doctor).
• You feel dizzy or faint when you stand up. Or you had a fall that hurt you in the last 12 months (see your own doctor).
• You have a bleeding problem, or you bruise or bleed easily. You are allergic to duloxetine. Or you are breastfeeding (see your own doctor).
• You take another antidepressant (SSRI, SNRI or other), or another medicine for mood, anxiety, or bipolar disorder, besides the duloxetine from this visit. Or you take a migraine triptan, an amphetamine, St. John's wort, or tryptophan (see your own doctor).
• You take a muscle relaxer, a blood thinner, or a heart rhythm medicine. Or you took aspirin or an anti-inflammatory pill in the last 7 days, even if only sometimes (see your own doctor).
• You take a phenothiazine, like thioridazine, promethazine, or prochlorperazine. Or you take fluvoxamine (Luvox), cimetidine (Tagamet, Tagamet HB), or ciprofloxacin (Cipro) (see your own doctor).
• You have taken duloxetine for about 12 weeks (see your own doctor, who takes over then).
• You are pregnant, might be, or are trying to get pregnant (see your pregnancy doctor or midwife).
• If more than one fits, follow the first one.