Summary: A new study shows that neuropathy is more common in clinical practice than believed. In the study, half of the patients had diabetes and two-thirds had metabolic syndrome. Neuropathy was present in 73% of them. Worse, most cases had never been caught. The study found that 75% of those with neuropathy had no prior diagnosis.
Many people live with neuropathic pain (pain from damaged nerves). Neuropathy causes more than pain. It also hits the nerves that carry feeling, so hands and feet tingle. People with peripheral neuropathy may also have autonomic neuropathy. That damages the nerves that run the organs, and other health problems follow.
Neuropathy is also linked to falls and a worse quality of life. Neuropathic pain is hard to treat. It brings a lot of emotional distress, depression, and other mental health problems.
Neuropathy often starts years before a doctor names it. There are several reasons for the delay. Patients may not seek care early enough. Many general physicians are not trained to catch it early. Worse, few people know how common it is. That is why it made sense to study how common it is in primary care clinics.
A new study by Elafros and colleagues from the University of Michigan, US, was published in the journal Neurology. It looked at how common distal symmetric polyneuropathy (DSP) is in Medicaid patients over 40 years of age. DSP is nerve damage on both sides of the body that starts in the feet and hands.
How common is undiagnosed neuropathy?
The study collected data from 169 patients in Flint, Michigan. Neuropathy is more common in people with metabolic disorders. So the team also collected fasting lipids and HbA1C. They found DSP with the modified Toronto Clinical Neuropathy Score. They measured its burden with the Peripheral Neuropathy Quality of Life Instrument–97.
Most patients were non-Hispanic blacks, at 69%. Men and women were about equal, and the average age was 58.2 years. The study had some surprises. DSP was present in 73% of patients. What shocked the researchers was that DSP had been missed in 75% of cases. They also found neuropathic pain in 57% of the patients with DSP.
Neuropathy was more common in people with metabolic syndrome. It also tracked with older age. But non-Hispanic Blacks had lower odds of neuropathy than non-Hispanic White and Hispanic participants.
Some findings were expected, like the link between neuropathy, older age, and metabolic syndrome. Neuropathy was less common among non-Hispanic Blacks. But that gap could be due to the small sample size.
The study had many limits. But one thing cannot be ignored: neuropathy was far more common than expected. Worse, it goes undiagnosed in so many cases. Missed neuropathy raises the risk of bad outcomes. It can also lead to the wrong treatment.
Why should neuropathic pain be treated at a specialized clinic?
Chronic pain is hard to manage. Worse, its cause often goes unnamed. That is why chronic pain belongs in a specialized clinic. Neuropathic pain also needs its own kind of treatment.
Doctors likely knew their patients had chronic pain. What they miss is that neuropathic pain is more common than many of them believe. When the cause of chronic pain goes unnamed, mood and emotional problems get poor care. That can even lead to substance abuse.
Last, neuropathic pain must be prevented, because reversing it is very hard.
Frequently asked questions
How do you know if you have neuropathy?
Neuropathy shows up as pain, tingling or other odd feelings in the hands and feet, because it damages the nerves that carry feeling. When it reaches the nerves that run the organs, other health problems follow. It also raises the risk of falls. It often starts years before anyone names it, so a doctor needs to test for it. The Michigan study used the modified Toronto Clinical Neuropathy Score.
Why does neuropathy so often go undiagnosed?
Three reasons. People with early neuropathy often do not seek care soon enough. Many general physicians are not trained to catch it early. And few people, doctors included, know how common it is. In the University of Michigan study, 73% of Medicaid patients over 40 had neuropathy, and 75% of them had never been diagnosed.
Who is most likely to have neuropathy?
People with metabolic problems and older adults. In the Michigan study, half the patients had diabetes and two-thirds had metabolic syndrome. Neuropathy was more common in those with metabolic syndrome and in older patients. The average age was 58. Non-Hispanic Black patients had lower odds than White and Hispanic patients. The small sample may explain that gap.
Why does it matter if neuropathy is missed?
Missed neuropathy raises the risk of bad outcomes. It can lead to the wrong treatment, because neuropathic pain needs its own approach. When the cause of chronic pain stays unnamed, the depression and distress that come with it go undertreated. That can even lead to substance abuse. Neuropathic pain is hard to reverse. That is why catching and preventing it early matters.
References
Elafros, M. A., Brown, A., Marcus, H., Dawood, T., Bachuwa, G. I., Banerjee, M., Winch, P. J., Kvalsund, M., Feldman, E. L., Skolarus, L. E., & Callaghan, B. C. (2024). Prevalence and Risk Factors of Distal Symmetric Polyneuropathy Among Predominantly Non-Hispanic Black, Low-Income Patients. Neurology, 102(11), e209390. https://doi.org/10.1212/WNL.0000000000209390
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Dr. Gurpreet Singh Padda, MD, MBA, MHP
