OBJECTIVES: The painful diabetic peripheral neuropathy (DPN) is the most common complication of diabetes. Despite the prevalence of painful DPN and its potential risk of foot ulcer and amputation, there has been no study about painful DPN on economic burden in Korea. This study was conducted to assess the patient-level economic burden among subjects with painful DPN. METHODS: A cross-sectional multi-center study was performed using a standardized questionnaire, to estimate recent 3 month health care and non-health care cost, and productivity loss of diabetic patients. A total of 4,000 patients were recruited from 40 hospitals between December 2009 and May 2010. Cost items mainly included health care cost such as outpatient, pharmacy, inpatient, and oriental medicine; non-healthcare cost such as traffic expenses, nursing cost, complementary and alternative medicine. Cost included insurance-covered cost as well as patient’s out-of-pocket expenses during 3 months. To estimate productivity loss due to morbidity, days away from work due to painful DPN were also investigated.  RESULTS: Among 2681 diabetic patients completed questionnaire (response rate = 67.0 %), 26.3% (n = 706) had painful DPN. Numbers of out-patient visit within 3 months were higher in patients with painful DPN compared to those in patients without painful DPN, 3.79 ± 2.83 and 3.25 ± 2.36, respectively (P <0.01).  Total costs over 3 months were also higher in patients with painful DPN than in those without painful DPN (1,049,477± 1,549,446 and 721,933 ± 1,394,970 KRW, respectively, P <0.01); Median costs were higher among patients with painful DPN (656,585 vs. 421,668 KRW). Within 3 months, 8.2% and 43.5% of patients with painful DPN had been away from work and reported the decreased work productivity, respectively. CONCLUSIONS: Painful DPN increased healthcare cost and decreased work-productivity of diabetic patients in Korea.