Pain-related medication use over time in patients 65 years or older with Diabetic Peripheral Neuropathy (DPN) were examined and compared to younger patients using Veteran's Health Administration (VA) claims for fiscal 2002, 2003, and 2004. Patients with DPN (ICD-9-CM codes 357.2 and 250.6) and at least one claim for a pain-related medication were included in the study. While there were no FDA-approved pharmaceutical agents for managing pain associated with DPN during the study period, a variety of medications are commonly used for this purpose. Pain-related medication utilization included pharmaceutical agents from any of the following five categories - anticonvulsants, antidepressants, short-acting narcotics, long-acting narcotics, or non-narcotic analgesics. We excluded patients with a diagnosis of schizophrenia, bipolar or depressive disorder, or anxiety. An average of 33,180 older and 20,687 younger patients per year were available for study purposes. Most patients were men (older cohort: 98.3%; younger cohort 97.1%). While agents from the non-narcotic analgesic category were the most frequently used pain-related medications in both older (67.7%) and younger (78.0%) patients over the study period, utilization of Cox-II Inhibitors only declined significantly for older patients from 2002 (65.7%) to 2004 (45.5%). Utilization of gabapentin and tramadol increased substantially among both cohorts, but by a lesser percentage among older patients (gabapentin: 24.4% to 30.5%; tramadol: 2.4% to 7.5%) than younger (gabapentin: 29.4% to 41.8%; tramadol: 3.4% to 11.1%). Utilization of agents from more than one category of pain-related medication was common, but less so among older than younger patients (48.7% versus 60.0%; p<.01). Differing patterns of use between age cohorts may reflect different strategies for managing pain in older DPN patients as a result of greater concerns about drug tolerability, differences in the manifestations of pain associated with DPN as the condition progresses, and/or changes in patient perceptions of pain as they age.