Prevalence and impact of pain in diabetic neuropathy

Abstract

Background: Diabetic neuropathy (DNP) is a serious and common complication of diabetes mellitus, with a prevalence of around 30–50%.Aims: To describe the prevalence, severity and medical treatment of painful DNP (PDNP) experienced by patients treated in secondary care; to determine quality of life (QoL) impact and the relationship between severity of pain and severity of DNP.Methods: Cross-sectional, two-phase survey. First, a pain interview was conducted by telephone (219 DNP patients), which covered types of pain, location and duration. Secondly, 50 patients were visited at home. Patients completed the Brief Pain Inventory, the Short Form Health Survey (SF–36) and the Hospital Anxiety and Depression Scale.Results: Prevalence of PDNP was 57.5%. Average and worst pain scores were 5.3±2.1 and 6.4±2.2, respectively (0–10 scale, 10 = worst pain imaginable). In 70% of patients, average pain was severe (score ≥5). Substantial interference by pain (score ≥4) was found in walking ability, sleep and normal activities. PDNP patients had a decreased QoL for all SF–36 domains (p≤0.01) except for health change. Moreover, symptoms of anxiety (36%) and depression (34%) were reported frequently. Medical treatment was prescribed in 46% of patients, in whom treatment was ineffective in 39%. Physical functioning scores were lower in patients with severe versus moderate DNP (p≤0.01).Conclusions: The prevalence of severe PDNP was high. Severity of DNP was not related to pain severity. PDNP was associated with loss of QoL and with symptoms of anxiety and depression. A considerable proportion of patients did not have medical treatment and, if treatment was given, its impact was disappointing. Medical treatment of PDNP was unsatisfactory and clearly needs to be improved.