title: The natural history of chronic painful peripheral neuropathy in a community diabetes population.
abstract: OBJECTIVE
  To examine the natural history of chronic painful diabetic neuropathy (CPDN).
  
  
  METHODS
  A cross-sectional study of 350 people with diabetes was performed during 1998-1999 to assess the prevalence of CPDN in the community. Fifty-six patients with CPDN were identified and were followed up an average of 5 years later.
  
  
  RESULTS
  From the original cohort, 12 patients had died and 14 had moved away or were unable to participate in the follow-up study. Thus 30 patients with CPDN [21 male, mean (SD) age 68.6 years (9.4), mean (SD) duration of diabetes 15.4 years (8.7)] were re-assessed. Seven (23%) had been pain free for at least 12 months and 23 continued to report neuropathic pain of similar quality and severity [total McGill Pain Questionnaire Score median (interquartile range) at follow-up 22 (16-39) vs. 20 (16-33) at baseline, P = 0.3; mean (SD) visual analogue scale (VAS) score for pain over the preceding 24 h 5.3 cm (2.9) vs. 4.6 cm (2.5) at baseline, P = 0.1]. Only 65% had ever received treatment for CPDN despite 96% (22/23) reporting pain to their physician; 43.5% had received antidepressants, 17.4% anticonvulsants, 39% opiates and 30% had tried complementary therapies.
  
  
  CONCLUSIONS
  The neuropathic pain of CPDN can resolve completely over time in a minority (23%). In those in whom painful neuropathic symptoms had persisted over 5 years, no significant improvement in pain intensity was observed. Despite the improvement in treatment modalities for chronic pain in recent years, patients with CPDN continue to be inadequately treated.
authors.affiliation: Diabetes and Endocrinology Clinical Research Group, University Hospital Aintree, Liverpool, UK. cdaousi@liverpool.ac.uk
authors.forename: C
authors.initials: C
authors.lastname: Daousi
authors.forename: S J
authors.initials: SJ
authors.lastname: Benbow
authors.forename: A
authors.initials: A
authors.lastname: Woodward
authors.forename: I A
authors.initials: IA
authors.lastname: MacFarlane
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D003153:Community Health Services; D003929:Diabetic Neuropathies / Q000150:complications*; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000188:drug therapy / Q000209:etiology*; D010147:Pain Measurement; D011379:Prognosis; D016896:Treatment Outcome