Epidemiology and natural history of chronic painful diabetic neuropathy

The Peripheral Neuropathy Solution

Peripheral Neuropathy Solution By Dr. Randall Labrum

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Estimates of the prevalence of chronic painful diabetic neuropathy (CPDN) vary substantially. In a hospital diabetic clinic population, 8% of patients had typical lower limb neuropathic symptoms, over twice that of a control group [2]. One study found that 11% of insulin-treated patients aged 15-59 years had painful symptoms [3] while another reported that 20% of patients with type 2 diabetes had neuropathic pain after 10 years of diabetes [4], although details of pain duration and severity were not given.

In a community-based study of patients with type 1 and 2 diabetes attending primary or secondary care clinics [5], using a structured questionnaire and examination, 350 people with diabetes were assessed and compared with 344 age- and sex-matched controls from the same locality. This is the largest study to date in which well-defined criteria of painful diabetic neuropathy and validated measures of pain severity and quality have been used, giving a better representation of the extent of the problem in the population with diabetes in the community. The estimated prevalence of chronic (>1 year's duration) painful diabetic neuropathy was 16.2% compared with 4.9% in the control sample. Pain was present across all age ranges and was equally common in those attending either hospital or community clinics. It was also revealed that CPDN was severe, frequently under-reported and undertreated in people with diabetes [5].

There is limited information regarding the natural history of painful neuropathy. Some longitudinal studies have shown a general tendency for painful neuropathic symptoms to improve [6-10] but others have found no change [11-13]. These conflicting results can be explained by the inclusion of patients with short duration of pain and with varying neuropathic syndromes which are known to have different prognoses [14]. Only three previous studies have concentrated on patients with neuropathic pain for over 6 months [9-11].

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