Chronic Painful Peripheral Neuropathy in an Urban Community: a Controlled Comparison of People With and Without Diabetes

Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Diabet Med. 2004;21:976-982.

Estimates of the prevalence of chronic painful peripheral neuropathy (CPPN) in the hospital-based setting have ranged from 11% to 20%. However, these estimates do not necessarily reflect the prevalence of CPPN in a community-based setting. The purpose of this study was to determine the prevalence, as well as severity and treatment type, of CPPN in patients with diabetes in a community-based setting.

Patients from 3 urban general practices, with a diabetes clinic at each, were invited to participate. A total of 350 subjects with type 2 diabetes and 344 control subjects without diabetes (matched by age, gender, and social class) were involved in the study. All patients underwent a physical examination and structured interview. Peripheral neuropathy was assessed using the neuropathy disability score (NDS), neuropathy symptom score (NSS), and pain symptom score (PSS). The severity and impact of CPPN was assessed using the McGill Pain Questionnaire, the Pain Visual Analogue Scale (VAS), and the Pain Disability Index (PDI).

Overall, 16.2% of patients with diabetes had CPPN compared with 4.9% of patients without diabetes (P<.0001). Of patients with diabetes and CPPN, 12.5% had never reported their symptoms to their physician, and 39.3% had never received treatment for their symptoms. No differences were found between patients with diabetes with CPPN and patients without CPPN in terms of age, sex, type or duration of diabetes, blood pressure, glycemic control, body mass index, smoking status, alcohol consumption, or serum creatinine. Patients with diabetes and CPPN had significantly higher 24-hour Pain VAS scores compared with patients with diabetes without CPPN (3.5 vs 0.7; P<.0001) and significantly higher pain severity ratings (18 vs 10; P<.0001).

The results of this study show that CPPN is a common diabetes-related complication that is under-reported and often goes untreated. It is important to identify and treat CPPN not only because it can lead to foot ulceration, but also because chronic pain has a significant impact on quality of life in terms of decreased independence, decreased mental and physical functioning, fatigue, sleep disturbance, anxiety, and depression.