2023-10-11 08:21:06
Despite being the most prevalent chronic complication in diabetes, it continues to be underdiagnosed, a fact that delays its prevention or adequate treatment. Pain in peripheral limbs is characteristic of diabetic neuropathy.
More than 25% of the Spanish population suffers from chronic pain, which lasts more than three months, according to the latest 2022 data from the Pain Barometer. Among these, neuropathic pain is caused by an injury or disease of the somatosensory nervous system that, although it represents between 20-25% of chronic pain and is one of the most complex to control, continues to be underdiagnosed and, consequently, not treated. properly.
Diabetic peripheral neuropathy (DPN) is one of the most common causes of neuropathic pain, the most prevalent chronic complication of diabetes and is characterized by causing damage to the nerves and causing intense pain in the legs, feet and hands. of every four people with diabetes.
It is “the most forgotten complication of this disease and, however, in the medium term, it will disable the person who suffers from it,” says José Angel Díaz Pérez, member of the Spanish Diabetes Society (SED).
In fact, the new international survey ‘Neuropathic Pain in Patients with Diabetes and Unmet Needs’ in which more than 960 Spanish patients participated, showed that the mood of 50% of people who suffer from this complication is very or totally affected.
Negative impact in all spheres
The same percentage of affectation appears with regard to the quality of sleep and the fact of playing sports. The ability to move is greatly or completely affected in the case of 40% of those who suffer from diabetic peripheral neuropathy; 42% in work activities and 40% in the case of daily activities and social and leisure activities. 38% of patients indicate that intimacy with their partner/sexual relations is also affected.
Diabetes, especially type 2, is already considered one of the ‘current great pandemics’ given its rising prevalence curve. Currently, almost half a billion people in the world suffer from diabetes and cases are expected to increase by 51% by 2027.
In Spain, six million people suffer from type 1 or 2; Of them, 1 in four will develop neuropathic pain, “a devastating complication,” according to Mercedes Maderuelo, manager of the Spanish Diabetes Federation (FEDE), whose diagnostic delay is around four months and with an average wait of six months. to obtain a confirmatory diagnosis, according to data from the aforementioned international survey, which highlights that 34% of those affected receive an erroneous diagnosis before the correct confirmatory diagnosis.
“Detection must be earlier since it is essential to optimize and individualize treatments,” claims Maderuelo, who emphasizes that physical pain, in some cases very intense and persistent, must be addressed and treated.
“The sooner it is diagnosed, the better the evolution will be in all areas and also taking into account the important negative psychological and emotional impact it generates: it prevents carrying out daily activities, which means reducing social and work life. The treatment should be adjusted, therefore, to the needs of each patient, so, before applying it, the patient’s opinion and vision must be shared.”
According to Díaz Pérez, the current approach to diabetic neuropathy reflects a reality of what is experienced every day in consultations. Of the complications of diabetes, he considers it to be the least studied, the least treated and where the least education is carried out. “It is one of the most neglected areas of this disease, unlike what happens in other complications such as nephropathy or diabetic retinopathy, for example.”
Thus, neuropathic pain is one of the most neglected complications of diabetes; the least studied and treated
It is a complication that is accompanied by pain and, in the medium term, work and social incapacity, which continues to present a late diagnosis. The reason is that, sometimes, “the care circuits between primary care physicians, diabetologists and pain specialists do not work as they should,” considers Díaz Pérez.
In your health area, for example, the prevalence of neuropathy is “more than 20% of the population with diabetes, a very high percentage” and almost always related to the evolution of diabetes – after ten years of diabetic disease, until 50% of patients may experience pain-, and poor metabolic control.
Prevention circuits
However, this professional points out, and agrees with the majority of diabetologists, that these are preventable complications.
Therefore, the proposal – which already works in some healthcare areas – is to implement and propose for the rest of the areas what are called Comprehensive Diabetes Care Units. “Their job is to ensure that all diabetics go through a primary care circuit once a year in which, in one day, all diabetes complications are analyzed. In this way, and in the case of neuropathy, it is possible to diagnose subclinical neuropathies, even asymptomatic, which allow preventive measures to be applied that can prevent the development of neuropathic pain.”
In addition to these prevention units, Díaz Pérez explains that, in the hospital setting, it would be very convenient to have “multidisciplinary action through specific hospital units, since the management of the disease cannot be done unilaterally.”
Long-standing patients with poor diabetes control tend to be the ones who develop this complication the most.
Although emphasis is placed on assessing risk profiles, the truth is that there are also unknown factors that lead to some diabetics developing painful neuropathy and others not.
However, “it has been observed that in most cases this complication develops in long-standing patients with poor control of the diabetic pathology. Thus, prevention and monitoring are the only forms of control. And if this is achieved in one out of every 100 patients, it will have been worth it,” considers the diabetologist.
Sensations of tingling, numbness, heat or stinging, and stabbing and/or irritating pain are the main initial symptoms of neuropathic pain associated with diabetes, explains María Madariaga, president of the Spanish Pain Society (SED). Furthermore, “between 50-80% of these symptoms are perceived as very or extremely annoying by patients.”
In his opinion, we are facing a complex issue to deal with: chronicity. “Chronic patients are those who have the greatest risk of having worse treatment, mainly because their illness or condition accompanies them throughout their lives, which leads them to live worse and for less time.”
Within chronic pain, patients with painful polyneuropathy appear, whether of diabetic origin or not, with a chronic neuropathic pain disorder that is difficult to control and has a low response to treatments.
But, despite the chronic nature, not everything is shadows. Madariaga believes that “patients have a great opportunity to free themselves or to have this problem never occur with adequate prevention and education programs.”
Recognize, however, that not all chronic pain conditions are equally preventable. This is why common work between professionals and those affected is so important to make visible and enhance the work of diabetologists, endocrinologists and multidisciplinary units that, together with primary care and pain units with the presence of a full-time psychology expert, is essential. for the adequate control of this complication.
The objective is to “treat the diagnosed patient as soon as possible and prevent, as much as possible, the development of this complication. The ideal is that the patient does not reach the hospital,” says the specialist.
For this, diabetes education for the patient is essential – so that they know that they must have exhaustive control of their blood glucose levels throughout their lives -, in addition to the training of professionals – doctors, nursing, physiotherapy, psychology – in “early diagnosis.” of this pathology to prevent this polyneuropathy, which at first is indolent, from ending up producing pain due to an increase in the diabetic neuropathic lesion.”
Education and information empower
Information and diabetes education are fundamental weapons so that the patient can ‘fight’ painful peripheral neuropathy.
However, and according to data from the new international survey on neuropathic pain and its unmet needs, only 42% of diabetics declare they have information about neuropathic pain, a fact that, according to the patient representative, Mercedes Maderuelo, “ It leaves them unprotected to act as early as possible. We suffer and demand information.”
It has also revealed a clear lack of education in diabetes, since only 45% of patients have received specific education for their underlying disease – which also causes cardiovascular and visual complications -, and much less education related to neuropathy. diabetic. Raquel Serrano
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