An older man with painful peripheral polyneuropathy

Anthony is a 59-year-old man who has been an infrequent patient of your practice over the past decade. His known problems include hypertension, for which he takes ramipril 5 mg daily, and obesity (his body mass index is 30 kg/m²). Two years ago he had a fasting glucose test, the result of which was in the impaired glucose tolerance range, but he has not returned for follow up. Anthony presents today with an eight-month history of bilateral lower leg and foot pain, associated with numbness over the feet. The pain is now keeping him awake at night. His hands are not affected. You are concerned Anthony has a neuropathic pain process, specifically painful peripheral polyneuropathy.