Painful Diabetic Neuropathy

N europathic pain exerts a substantial impact on quality of life, particularly by causing considerable interference in sleep, daily activities, and enjoyment of life. Chronic neuropathic pain is present in 13–26% of diabetic patients (1– 4). In a recent survey from Augsburg, Germany, the prevalence of painful polyneuropathy was found to be 13.3% in diabetic subjects, 8.7% in individuals with impaired glucose tolerance, 4.2% in individuals with impaired fasting glucose, and 1.2% in individuals with normal glucose tolerance (3). Independent factors significantly associated with diabetic painful neuropathy (DPN) were age, weight, and peripheral arterial disease. Pain is a subjective symptom of major clinical importance, since it is often this complaint that motivates patients to seek health care. However, in a survey from the U.K., only 65% of diabetic patients received treatment for their neuropathic pain, although 96% had reported the pain to their physician. Pain treatment consisted of antidepressants in 43.5% of cases, anticonvulsants in 17.4%, opiates in 39%, and alternative treatments in 30% (combinations possible). Whereas 77% of the patients reported persistent pain over 5 years, 23% were pain free over at least 1 year (1). Thus, neuropathic pain persists in the majority of diabetic patients over periods of several years.