Stepwise Deprescribing and Combined Korean Medicine Treatment in a Patient with Painful Diabetic Polyneuropathy under Polypharmacy: A Case Report

Background: Painful diabetic polyneuropathy (PDPN) is a common and difficult-to-manage complication of diabetes mellitus, particularly in older adults with polypharmacy. This case report describes the in-hospital clinical course observed during stepwise deprescribing and combined Korean medicine treatment in a patient with PDPN experiencing polypharmacy.Case Report: A 67-year-old woman with a 20-year history of diabetes mellitus was admitted with severe bilateral lower-extremity pain and dysesthesia. At admission, she was taking 30 medications, including gabapentin, pregabalin, amitriptyline, and opioid analgesics; however, her pain remained poorly controlled. Her symptoms were characterized by distal-dominant pain, allodynia, nocturnal exacerbation, and sleep disturbance. Combined Korean medicine treatment, including <i>Sogyunghwalhyeol-tang-gamibang</i>, acupuncture, electroacupuncture, moxibustion, Hominis placenta pharmacopuncture, and transcutaneous electrical nerve stimulation, was administered during hospitalization. Concurrently, medications with overlapping pharmacologic effects or limited clinical utility were gradually reduced or discontinued through interdisciplinary consultation. During hospitalization, the total number of medications decreased from 30 to 16. Right lower-extremity pain decreased from a Numerical Rating Scale (NRS) score of 9 to 5, and left lower-extremity pain decreased from 5 to 3. The total Short-Form McGill Pain Questionnaire score decreased from 44 on hospital day 1 to 16 on hospital day 28.Conclusion: This case describes an in-hospital clinical course in which pain-related outcomes improved during stepwise deprescribing and combined Korean medicine treatment in a patient with PDPN experiencing polypharmacy, suggesting the potential clinical applicability of medication reassessment and integrative treatment.