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One of the most common complications associated with diabetes is neuropathic pain associated with diabetic peripheral neuropathy of the feet (DPN), more commonly referred to as diabetic nerve pain. 2
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There are at least 5 million Americans in the US that suffer from painful DPN and 2.5 million (i.e., 50%) have unresolved pain despite first line treatments.
The symptoms associated with this nerve damage may be painful and include numbness, tingling, as well as burning, shooting or stabbing sensations that most often affect the extremities.3 Not all DPN is painful and many times the early symptoms start with numbness, pins and needles.
DPN is progressive and often starts with some tingles here and there – then it intensifies. As patients begin to lose important sensory information, they gain disruptive (and chronic) sensations like burning, pins and needles.
It is a progressive and debilitating complication of diabetes that was predicted to affect approximately more than 5 million Americans in 2021 and is expected to double by 2030.4-8
Some symptoms have been described by patients as:
Tingling: I feel “pins and needles” in my feet.9
Pain: I have burning, stabbing or shooting pains in my feet.9
Increased Senstivity: My feet are very sensitive to touch. For example, sometimes it hurts to have the bed covers touch my feet.9
Numbness or Weakness: I can’t feel my feet when I’m walking.
In recent years, the lack of effective, innovative treatment options have left many patients with a significant unmet medical need. While opioids have often been prescribed for the treatment of DPN, this treatment comes with risks and there is no substantial evidence that they are effective long term.
In February 2022, the Centers for Disease Control and Prevention (CDC) issued new draft guidance for clinicians who are prescribing opioids for outpatients with acute, subacute, or chronic pain.
The high use of opioids in people with painful diabetic neuropathy occurs despite the 2017 American Diabetes Acadamy position statement for DPN states that opioids, given safety concerns, are not recommended for use as first- or second-line agents. In addition, the recent 2021 American Academy of Neurology guidelines do not recommend the use of opioids for PDPN.
Now a new education campaign is underway which asks patients who are living with painful DPN and remain dissatisfied with treatment options to submit a short mnemonic acronym to help fellow patients experiencing painful DPN identify ways to describe their symptoms to healthcare providers.
The winning mnemonic will be included in a painful diabetic neuropathy toolkit and released for patients to help support empowered conversations with healthcare providers about solutions to symptoms and available/potential treatment options.
Kathy Sapp, CEO of the American Chronic Pain Association (ACPA), a foundation offering peer support and education in pain management and David Armstrong, DPM, MD, PhD USC Schaeffer Center, to discuss the need to increase awareness and recognition of painful DPN symptoms. They will also talk about building confidence to talk to your healthcare provider, being an empowered advocate for your treatment options and discuss the new education campaign.
Interview is courtesy of Averitas Pharma, Inc.
References:
1. A Snapshot Diabetes in America. https://www.cdc.gov/diabetes/library/socialmedia/infographics/diabetes.html. Accessed 2022..
2. University of Chicago Center for Peripheral Neuropathy. Types of Peripheral Neuropathy. http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/diabetes/diabetes.shtml. Accessed 2021.
3. American Diabetes Association. Peripheral Neuorapthy Overview. https://www.diabetes.org/diabetes/complications/neuropathy/peripheral-neuropathy. Accessed 2021
4. Gore M. et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J. Pain. 2006. 892-900.
5. Veves A. et al. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Medicine. 2008. 660-674.
6. Gore, M., Brandenburg, N. A., Dukes, E., Hoffman, D. L., Tai, K.-S., & Stacey, B. (2005). Pain Severity in Diabetic Peripheral Neuropathy is Associated with Patient Functioning, Symptom Levels of Anxiety and Depression, and Sleep. Journal of Pain and Symptom Management, 30(4), 374-385. doi:10.1016/j.jpainsymman.2005.04.009.
https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
7. Iqbal Z. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clinical Therapeutics. 2018. 828–849.
8. International Diabetes Federation. IDF diabetes atlas, ninth edition. 2019.
9. https://www.diabetes.org/diabetes/neuropathy/peripheral-neuropathy.
10. CDC Division of Diabetes Translation, National Diabetes Statistics Report, 2020. https://www.cdc.gov/diabetes/library/features/diabetes-stat-report.html#:~:text=New%20in%202020%2C%20the%20report,1%20in%203%E2%80%94have%20prediabetes. Accessed 2021.
11. University of Chicago Center for Peripheral Neuropathy. Types of Peripheral Neuropathy. http://peripheralneuropathycenter.uchicago.edu/learnaboutpn/typesofpn/diabetes/diabetes.shtml. Accessed 2021.
12. American Diabetes Association. Peripheral Neuorapthy Overview. https://www.diabetes.org/diabetes/complications/neuropathy/peripheral-neuropathy. Accessed 2021
13. Gore M. et al. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J. Pain. 2006. 892-900.
14. Veves A. et al. Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Medicine. 2008. 660-674.
15. Gore, M., Brandenburg, N. A., Dukes, E., Hoffman, D. L., Tai, K.-S., & Stacey, B. (2005). Pain Severity in Diabetic Peripheral Neuropathy is Associated with Patient Functioning, Symptom Levels of Anxiety and Depression, and Sleep. Journal of Pain and Symptom Management, 30(4), 374-385. doi:10.1016/j.jpainsymman.2005.04.009.
https://www.cdc.gov/media/releases/2017/p0718-diabetes-report.html
16. Iqbal Z. Diabetic peripheral neuropathy: epidemiology, diagnosis, and pharmacotherapy. Clinical Therapeutics. 2018. 828–849.
17. International Diabetes Federation. IDF diabetes atlas, ninth edition. 2019.
18. Centers for Disease Control and Prevention. Diabetes Report Card 2019. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services; 2020.
https://www.cdc.gov/diabetes/pdfs/library/Diabetes-Report-Card-2019-508.pdf Accessed 2021.
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