Objective: To study the effect of addition of Metanx on burning parasthesias in patients with symptomatic diabetic neuropathy who had obtained only partial symptom resolution with pregabalin. Research design and methods: This was an open-label pilot study. There were 16 patients (7 males, 9 females) in the study group and 8 patients (3 males, 5 females) in the control group. A patient numeric rating scale (0 - 10) of neuropathy associated pain was obtained at baseline and at 20 weeks. The control group continued on a fixed dosage of pregabalin (Lyrica) without additional medication, while the study group was supplemented with Metanx (L-methylfolate, methylcobalamin, and pyridoxal 5- phosphate), in addition to being continued on a fixed dosage of pregabalin. Results: After 20 weeks, patients in the study group experienced greater pain relief compared to the control group, (87.5% vs. 25% respectively, p = 0.005). The average pain score reduction after 20 weeks in the study group was 3 compared to0.25 inthe control group (p < 0.001). Conclusion: Our study suggested that addition of Metanx may be used for the relief of pain in patients that have obtained only partial resolution of symptomatology from pregabalin.