Final answer:
First-line therapies for painful diabetic neuropathy in a patient with a cardiac history include antidepressants like duloxetine and anticonvulsants such as pregabalin or gabapentin, complemented by non-pharmacological treatments.
Step-by-step explanation:
The treatment of choice for painful diabetic neuropathy in a 65-year-old male with a cardiac history should be approached with caution due to the potential for adverse cardiac effects. First-line therapies usually include certain antidepressants such as duloxetine or anticonvulsants like pregabalin or gabapentin, which are effective for neuropathic pain and generally have a safe cardiac profile. However, it is crucial to consider the individual patient's cardiac history and to consult with a healthcare provider to determine the safest and most effective therapeutic option. Non-pharmacological treatments such as physical therapy, proper foot care, and potentially transcutaneous electrical nerve stimulation (TENS) may also be recommended as complementary strategies to relieve symptoms.a