Abstract
ObjectiveOur aim was to estimate the prevalence of distal chronic pain with neuropathic characteristics in patients with type 1 and type 2 diabetes mellitus and its impact on quality of life, mood, anxiety, sleep and healthcare utilization.MethodsIn total, 885 patients were screened and 766 diabetic patients (38.7% with type 1 diabetes mellitus, 44.8% women, mean age: 57.2±14.9 years) were enrolled consecutively over a three-month period in this observational study by 85 diabetes specialists working in a hospital department or in private practice. All the patients completed a series of questionnaires for the detection of chronic pain (i.e. daily pain for more than three months) in the lower limbs and assessment of health-related quality of life (Medical Outcomes Short Form 12 scale), sleep disturbances (MOS sleep scale), depression and anxiety (Hospital Anxiety and Depression scale). Patients with chronic pain were also assessed with the 7-item DN4-interview questionnaire, the monofilament test and the Michigan Neuropathy Screening Instrument (MNSI).ResultsThe overall prevalence of chronic pain with neuropathic characteristics was 20.3% [95% CI 17.4–23.1]. The MNSI examination score suggested that pain was related to polyneuropathy, in 80.1% of these patients (89.5% of those with bilateral pain). Patients with chronic pain had a poorer quality of life and more sleep disturbances, anxiety and depression than patients without pain and the presence of neuropathic characteristics was predictive of such impairments. Only 38.6% of the patients had received appropriate treatment for neuropathic pain.ConclusionsChronic pain with neuropathic characteristics concerns one in five diabetic patients, has a significant impact on quality of life and is not adequately managed. The close correlation between the DN4 questionnaire and MNSI results suggests that screening tools for neuropathic pain could be used in daily practice for the identification of painful diabetic polyneuropathy.
Highlights
Sensory distal polyneuropathy is a common complication of diabetes, affecting about 50% of the patients
The prevalence of painful diabetic polyneuropathy (PDPN) remains unclear, with estimated prevalence ranging from 10 to 60% of diabetic patients, probably reflecting differences in the diagnostic criteria used in different studies [3,4,5]
Pain associated with diabetic polyneuropathy is, by definition [6], neuropathic, and has a number of clinical characteristics in common with other neuropathic pain syndromes related to various lesions or diseases of the nervous system [7,8]
Summary
Sensory distal polyneuropathy is a common complication of diabetes, affecting about 50% of the patients. In the last few years, several clinical tools, in the form of simple questionnaires, have been developed and validated for the screening of neuropathic pain, for use in both clinical research and daily clinical practice [9,10]. These tools based on the identification of specific pain qualities, rely mostly on the terms used by the patients to describe their pain (pain descriptors) and have been shown to have excellent sensitivity and specificity for the identification of neuropathic pain in various populations of patients [10]. Not specific to diabetes, these clinical tools could improve the identification of painful diabetic neuropathy
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