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American Academy of Neurology guidelines on treating painful DPN recommend that clinicians evaluate oral, topical and nonpharmacologic therapies for patients with painful diabetic polyneuropathy, and emphasizes switching between drug classes rather than trying multiple agents within the same class if one fails [63]

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Most patients report that early nausea and digestive changes improve significantly once their body adjusts to the medication

The widely repeated claim that Dihexa is "seven orders of magnitude more potent than BDNF" originates from that flagged McCoy paper and reflects an assay-specific in-vitro spine-density measurement picomolar Dihexa versus nanomolar BDNF in one assay not a millions-fold advantage in a living brain