Diabetic Polyneuropathy: Is Pain a Component?

Diabetic polyneuropathy (DPN) can exist with or without neuropathic pain. Roughly half of patients with types I and II diabetes mellitus (DM) develop DPN. In type 1 DM, patients start to notice symptoms of distal polyneuropathy after many years of chronic prolonged hyperglycemia. It’s more aggressive in type 2 DM, and can develop after only a few years of known poor glycemic control and may be present at diagnosis. A study published in the electronic journal Health and Quality of Life Outcomes examines neuropathic pain’s affect on quality of life in diabetic patients with consideration of comorbidities.

The researchers compared 80 patients with painful DPN to 80 patients with DPN who had no neuropathic pain component (control group), and they used a variety of valid instruments to assess neuropathic symptoms and signs, pain, quality of life and depression.

Patients who reported pain were more likely to also report sleeping disorders or problems regarding micturition and defecation. Their walking distances were reduced compared to controls. A noteworthy finding: patients who reported pain also had significantly more compromised carotid arteries as confirmed by color-doppler sonography.

Patients who reported pain as a component of DPN were significantly more likely to report a lower quality of life than comparators. As would be expected, patients who experienced pain were more likely to be medicated and were significantly more likely to be taking tramadol, antiepileptics, and antidepressants.

Patients who reported no pain indicated they had better quality of life than patients who had pain. This study was conducted in Croatia, and patients reported a somewhat higher quality of life compared to its general population. The researchers indicate this finding was unexpected. They suggest that this arm of the study had more male subjects who tended to me more educated than the general population, which may account for the difference in reported quality of life.

The authors conclude that since DPN influences various aspects of quality of life in diabetic patients, aggressive treatment of pain is warranted.