title: Effective pharmacological treatment of painful diabetic neuropathy by nurse practitioners: results of an algorithm-based experience.
abstract: OBJECTIVE
  To improve the care of patients with painful diabetic polyneuropathy (PDP) by a specialized outpatient clinic for individuals referred by general practitioners and to determine the effects on pain, quality of life, and patient satisfaction.
  
  
  METHODS
  One hundred twenty-one patients were prospectively enrolled. At baseline and after 12 months at end of treatment, patients filled in a set of validated questionnaires on severity and interference of pain, quality of life, anxiety and depression, and patient satisfaction with the service offered.
  
  
  METHODS
  The outpatient clinic is part of a regional chronic care management program, which includes both hospital-based endocrinologists and general practitioners.
  
  
  RESULTS
  Twenty-eight patients (27%) did not need any further treatment after one visit to the outpatient clinic. As initial drug, pregabalin was the most commonly prescribed drug (65%); amitriptyline was prescribed in only 30% due to its contraindications. Improvements were found in all pain scores (P < 0.05). Pain interference was improved in sleep (P < 0.01), general activity, and mood (P < 0.05). More than half of the patients (65%) were satisfied with the treatment and wished no further medication changes; 52% had a treatment success defined as pain relief ≥ 30%. Medication was stopped due to inefficacy in 9% of patients and changed due to adverse effects in 20% of the patients.
  
  
  CONCLUSIONS
  A specialized outpatient clinic for patients with PDP is an effective health care service. Using diagnostic instruments and a defined treatment algorithm, significant pain reduction was achieved in the majority of patients in a relative short period of time.
authors.affiliation: Departments of Patient and Care Internal Medicine, Division of Endocrinology, Medical University Center Maastricht, P. Debyelaan 25, Maastricht, The Netherlands. m.geerts@mumc.nl.
authors.forename: Margot
authors.initials: M
authors.lastname: Geerts
authors.forename: Sabine A N T
authors.initials: SA
authors.lastname: Landewé-Cleuren
authors.forename: Marleen
authors.initials: M
authors.lastname: Kars
authors.forename: Hubertus J M
authors.initials: HJ
authors.lastname: Vrijhoef
authors.forename: Nicolaas C
authors.initials: NC
authors.lastname: Schaper
mesh_terms: D000465:Algorithms; D000553:Ambulatory Care; D000554:Ambulatory Care Facilities; D000700:Analgesics / Q000627:therapeutic use; D003929:Diabetic Neuropathies / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008297:Male; D009722:Nurse Practitioners; D010147:Pain Measurement / Q000379:methods*; D017060:Patient Satisfaction; D011788:Quality of Life
chemical_list: D000700:Analgesics