Appendix FNeuropathic Pain

Screening Tool for Neuropathic Pain

This simple, six-item questionnaire called the ID Pain questionnaire was developed and validated as an effective screening tool for neuropathic pain.1

Answer the following questions about your pain over the past week:

Yes Scores No Scores

Did the pain feel: Like pins and needles 1 0 Hot or burning 1 0 Numb 1 0 Like electric shocks 1 0Is the pain worse with touching by clothes or bed linens?

1 0

Is the pain limited to your joints? −1 0Total “yes” score

Add scores from all “yes” answers to get the total “yes” score. Scores ≥3 suggest likely neuropathic pain.

1 Portenoy R. Development and testing of a neuropathic pain screening questionnaire. ID pain. Curr Med Res Opin 2006;22:1555–1565

D. Marcus, Chronic Pain: A Primary Care Guide to Practical Management, 423© Humana Press, a part of Springer Science + Business Media, LLC 2009

Diabetic Neuropathy

Diabetes is the most common medical condition causing painful nerve damage, called neuropathy. You will typically notice a burning and numbness in your feet. Touching your feet may become unpleasant. One in every three patients with dia-betes will develop neuropathy.

A number of factors increase your risk of developing diabetic neuropathy:2

● Older age ● Long duration of diabetes ● Poor glucose control ● Elevated cholesterol and triglycerides ● Smoking ● Obesity ● Low physical activity

This graph shows the odds of developing a microvascular complication with diabetes, such as neuropathy or retinopathy (nerve damage in the eye) (Fig. F.1).3 An odds ratio number higher than 1 shows that this factor will increase your risk of developing neuropathy or retinopathy. An odds ratio of 2 means your risk is doubled. For exam-ple, the graph shows that your risk of developing these complications is doubled if you smoke, are inactive, and have poorly controlled blood sugars. Your risk is also elevated if your triglyceride level is elevated.

1.9

2.0

2.2

1.3

2.0

1.7

2.3

0 1 2 3

Older age

Type I diabetes

Long duration

High serum triglycerides

HbA1C 8 or higher

Low physical activity

Smoking

Adjusted odds ratio

Fig. F.1 Risk factors for microvascular complications with diabetes (based on McClean et al.3).

424 Appendix F Neuropathic Pain

2 Al-Mahroos F, Al-Roomi K. Diabetic neuropathy, foot ulceration, peripheral vascular disease and potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes clinic-based study. Ann Saudi Med 2007;27:25–313 McClean MT, Andrews WJ, McElnay JC. Characteristics associated with neuropathy and/or retinopa-thy in a hospital outpatient diabetic clinic population. Pharm World Sci 2005;27:154–158

While you cannot do anything to reduce your risk from age or how long you have been a diabetic, you can reduce other risk factors by doing the following:

● Discontinue tobacco ● Start or increase an aerobic exercise program ● Reducing your weight ● Keep your blood sugars under better control ● Reducing your blood lipid levels

Controlling these factors will help reduce your risk of developing neuropathy. Also, controlling blood sugars and other health factors can reduce the pain you experi-ence after you have already developed diabetic neuropathy.

Diabetic Neuropathy 425