Systematic literature review on the burden of illness in painful diabetic peripheral neuropathy

Abstract

This literature review examined the burden of pain in diabetic peripheral neuropathy (DPN) in the United States in terms of its clinical characteristics, epidemiology, economic and humanistic aspects. The review was conducted using Medline with unlimited years. DPN is a neuropathic disorder associated with diabetes mellitus. It is the most common form of peripheral neuropathy and mainly affects the distal extremities of diabetic patients. It is characterized by the presence of positive (e.g. burning/knife like pain) and negative (e.g. numbness) symptoms, as well as the presence of other co-morbidities such as depression, anxiety and sleep disturbance. In the US, the prevalence of DPN has been estimated at between 20-30% of diabetic patients and painful positive symptoms occurring in approximately 30% of DPN patients. This review has found that there are considerable problems with the early identification of this condition and the utilization of medications that have demonstrated clinical effectiveness in the alleviation of symptoms. The humanistic burden has been broadly characterized with large impacts in the area of pain, mobility, usual activities and sleep. One study examining 265 painful DPN patients found the comorbidity of other chronic pain conditions was high (62.7%). These impacts related to the unsatisfactory relief of pain emphasize the still unmet need for effective therapies for this patient population. The economic burden of DPN is only partially understood. Annual medication costs are on the order of $1,004 per patient per year in the US and total health care costs for neuropathic pain patients ($17,355) triple that of matched control subjects ($5,715). Indirect costs of DPN are also substantial with 64.5% of patients reporting some decline in productivity. As the economic burden may be substantial, additional research is required to fully characterize the impact of painful DPN on economic variables and the relative cost-effectiveness of treatment alternatives. This literature review examined the burden of pain in diabetic peripheral neuropathy (DPN) in the United States in terms of its clinical characteristics, epidemiology, economic and humanistic aspects. The review was conducted using Medline with unlimited years. DPN is a neuropathic disorder associated with diabetes mellitus. It is the most common form of peripheral neuropathy and mainly affects the distal extremities of diabetic patients. It is characterized by the presence of positive (e.g. burning/knife like pain) and negative (e.g. numbness) symptoms, as well as the presence of other co-morbidities such as depression, anxiety and sleep disturbance. In the US, the prevalence of DPN has been estimated at between 20-30% of diabetic patients and painful positive symptoms occurring in approximately 30% of DPN patients. This review has found that there are considerable problems with the early identification of this condition and the utilization of medications that have demonstrated clinical effectiveness in the alleviation of symptoms. The humanistic burden has been broadly characterized with large impacts in the area of pain, mobility, usual activities and sleep. One study examining 265 painful DPN patients found the comorbidity of other chronic pain conditions was high (62.7%). These impacts related to the unsatisfactory relief of pain emphasize the still unmet need for effective therapies for this patient population. The economic burden of DPN is only partially understood. Annual medication costs are on the order of $1,004 per patient per year in the US and total health care costs for neuropathic pain patients ($17,355) triple that of matched control subjects ($5,715). Indirect costs of DPN are also substantial with 64.5% of patients reporting some decline in productivity. As the economic burden may be substantial, additional research is required to fully characterize the impact of painful DPN on economic variables and the relative cost-effectiveness of treatment alternatives.