Peripheral neuropathy (PN), a condition characterized by numbness, pain, or a burning sensation in the feet, often remains undiagnosed or misdiagnosed for other painful conditions. This is a significant issue as neuropathic pain is associated with three times higher healthcare expenditure due to anxiety, depression, and sleep disturbance[1].
A recent study by Gad et al. with our long-time friend Rayaz Malik as senior author (2024) highlights the importance of early diagnosis of PN, particularly diabetic peripheral neuropathy (DPN), the most common form of PN. The authors argue that earlier diagnosis could reduce morbidity and enable earlier risk factor reduction to limit disease progression[1].
The Current State of PN Diagnosis
Currently, the 10g monofilament test is endorsed as an inexpensive and easily performed test for DPN. However, it only detects patients with advanced neuropathy at high risk of foot ulceration[1].
There are many validated questionnaires to diagnose PN, but they can be time-consuming and have complex scoring systems. Primary care physicians (PCPs), who often have busy clinics, lack access to a readily available screening method to diagnose PN. They would prefer a short, simple, and accurate tool to screen for PN[1].
The Gap in PN Diagnosis
A lack of awareness of the symptoms among patients may lead to an approximately 5-year delay in the diagnosis and treatment of PN. Patients tend to only report symptoms that have a substantial impact on their daily activities, work, mobility, and sleep. Milder neuropathic symptoms are often perceived as a normal sign of aging or are simply not complained about, as it may be seen as a sign of weakness in some cultures[1].
Physicians do not proactively ask patients for symptoms of PN as they prioritize other complications of diabetes, such as retinopathy, nephropathy, and cardiovascular disease. Even if patients complain of neuropathic symptoms, there are no readily available diagnostic tools in the clinic[1].
Bridging the Gap
The study by Gad et al. (2024) proposes a consensus to help improve the diagnosis of PN in primary care using a simple tool for patients to screen themselves for PN followed by a consultation with the physician to confirm the diagnosis[1].
The consensus includes the following key points:
- “Community awareness” is critical in raising awareness and increasing understanding of the importance of nerve health and potential risk factors for PN among the general population.
- “Group education” may improve patients’ knowledge, health behavior, and quality of life.
- “Physician education” regarding when and how to treat and when to refer to a neurologist or pain specialist is needed.
- “TeleNeuropathy screening” could be a viable option, especially in the era of telemedicine[1].
In conclusion, the study by Gad et al. (2024) underscores the urgent need for a more effective approach to diagnosing PN in primary care. By implementing the proposed consensus, we can hope to reduce the morbidity associated with PN and improve the quality of life for patients suffering from this condition.
Citations:
[1] https://onlinelibrary.wiley.com/doi/10.1111/jns.12613
Leave a Reply