Supplements Effective Management of Painful Neuropathies: A Disease Management and Cost of Care Analysis
Review of Painful and Nonpainful Neuropathies: Issues Surrounding Patient Care
It is estimated that 50 million people in the
United States suffer from chronic painthe number one cause of disability in this
country.1 Pain is the primary reason for seeking
healthcare, resulting in more than $100
billion in direct medical costs each year.2
Pain is complex and has been defined along
several dimensions that have helped to guide
both research and clinical practice. One of the
most important divisions for the diagnosis and
treatment of chronic pain is nociceptive versus
neuropathic pain (NP). Nociceptive pain
results from events that produce tissue damage
or that may be damaging to tissues.3,4 In
contrast, NP arises secondary to nervous system
damage or dysfunction and is often maintained
long after demonstrable damage to
tissues has healed.3,5,6
NP has a profound negative impact on
quality of life7 and can be difficult to treat.
Although the overall prevalence of NP is not
known, painful diabetic peripheral neuropathy
(DPN) is a common complication of longstanding
diabetes, a disease that affects
nearly 21 million people in the United
States.8,9 The first article in this supplement
reviews the etiology and diagnosis of NP, with
a focus on 2 of the conditions most often
associated with this condition, DPN and
postherpetic neuralgia (PHN). This article
points out that patients with DPN or PHN
may present with a variety of NP symptoms,
and it is important to distinguish these conditions
from other pain syndromes so appropriate
therapy can be initiated.
The second article reviews the societal
and patient burdens associated with NP. The
presented results document the profound
negative impact of NP on quality of life and
the particularly debilitating effects of the
triad of chronic pain, sleep disturbances,
and depression/anxiety that is present in
many patients with NP. It is critical that
patients with NP be evaluated for comorbidities
and that integrated therapy address
both pain and other patient conditions to
restore functionality and quality of life.
The third article reviews current therapy
for NP. Although a wide range of agents have
been used to treat people with this condition,
only 4 (ie, lidocaine patches 5%, duloxetine,
gabapentin, and pregabalin) are
approved for the treatment of painful DPN
and PHN. The clinical efficacy and safety of
these agents are reviewed in detail. The
information in this supplement will provide
practitioners with increased understanding
of how to assess, treat, and manage patients
with conditions that give rise to NP, as well
as how to deal with their comorbidities.
Corresponding author: Bill McCarberg, MD, Chronic Pain Management Program, Kaiser Permanente, 732 North Broadway, Escondido, CA 92025. E-mail: firstname.lastname@example.org.
1. Pal S. Prevalence of chronic pain and migraine. Pharmacist. 2005;3:12-15.
2. Eksterowicz N. It's the decade of pain control and research: are we really making a difference? Nurse Reporter. 2004;1:18-24.
3. Goucke CR. The management of persistent pain. Med J Aust. 2003;178:444-447.
4. American Academy of Pain Medicine. Management of chronic pain syndromes: issues and interventions. Pain Med. 2005;6(suppl 1):S1-S20.
5. Chen H, Lamer TJ, Rho RH, et al. Contemporary management of neuropathic pain for the primary care physician. Mayo Clin Proc. 2004;79:1533-1545.
6. Dworkin RH, Backonja M, Rowbotham MC, et al. Advances in neuropathic pain: diagnosis, mechanisms, and treatment recommendations. Arch Neurol. 2003;60:1524-1534.
7. Vinik EJ, Hayes RP, Oglesby A, et al. The development and validation of the Norfolk QOL-DN, a new measure of patients' perception of the effects of diabetes and diabetic neuropathy. Diabetes Technol Ther. 2005;7:497-508.
8. Dyck PJ, Kratz KM, Karnes JL, et al. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43:817-824.
9. National Diabetes Information Clearinghouse. National Diabetes Statistics. NIH Publication No. 06-3892. 2005. Available at: http://diabetes.niddk.nih.gov/dm/pubs/statistics/index.htm#7. Accessed May 3, 2006.