September is Global Pain Awareness Month, a time to raise public awareness and understanding of pain and pain management. Pain conditions affect a great number of people with 30 per cent of the world’s population affected by chronic pain, meaning they have been living with persistent or recurrent pain for periods longer than three months1,2.
To learn more about the impact of neuropathic pain (NeP) and the unmet needs of diabetes sufferers, Viatris conducted a new survey3, involving 963 patients from Italy, Spain, Malaysia, Mexico, and South Korea.
Neuropathic pain (NeP) is defined as pain caused by a lesion or disease of the somatosensory nervous system. While this condition accounts for 20 to 25 per cent of chronic pain, it is still commonly underdiagnosed with patients not receiving appropriate treatment4-7. One of the most common causes of NeP is diabetic peripheral neuropathy (DPN), which is the most prevalent chronic complication of diabetes since it causes nerve damage leading to severe pain in the feet, legs, and hands.
One in four people with diabetes can develop painful diabetic peripheral neuropathy (pDPN)8. This affects people’s ability to perform daily activities and greatly impacts their quality of life from both an emotional and practical perspective. People living with diabetes and NeP describe pain in their feet or lower limbs as ‘hot burning flames from a fire’, prickling ‘thin pins and needles’, ‘electric shocks from a violent lightning bolt’, sharp pains from a ‘stabbing knife’, hundreds of ants ‘crawling in an annoying and nagging way’ and they experience worry, anxiety, and fright.
Today, nearly half a billion people have diabetes worldwide and, as cases are expected to increase by 51 per cent by 20247, the associated complication of NeP is equally becoming a growing concern.
Patients’ awareness and hope about their symptoms
According to the survey, 68 per cent of patients in Malaysia claimed to be aware of the association between pain symptoms and diabetes before their diagnosis. Nevertheless, from the initial onset of symptoms, the main thoughts that crossed patients’ minds were a connection to other existing conditions (25 per cent); a hope that they would go away (39 per cent); a connection to aging (40 per cent); a temporary condition (36 per cent).
Diagnosis experience
On average, the majority of respondents globally contacted a physician within four months from the first signs and symptoms and received their diagnosis within six months from the onset of their symptoms. In Malaysia, the prevalent HCP responsible for the diagnosis was an endocrinologist, for 68 per cent of respondents, but also general practitioners and pain specialists played an important role for seven per cent and five per cent of respondents, respectively. However, misdiagnosis is still an issue with 63 per cent of respondents in Malaysia claiming to have received an incorrect diagnosis before the final one.
Painful diabetic peripheral neuropathy (pDPN) affects patients’ mood and ability to perform daily activities
Living with pDPN greatly impacts different aspects of a person’s life, both emotionally and practically, as confirmed by nearly half of the patients interviewed who claimed that their quality of life is very much or completely affected by the condition. Indeed, 75 per cent of patients in Malaysia stated that they had to adjust their work schedules while 61 per cent even took a long absence from work.
37 per cent of respondents in Malaysia claimed that pDPN has had an impact on their overall mood; their ability to play sports (48 per cent) and the quality of their sleep (37 per cent). However, despite its significant impacts, only one in five patients globally feel they can talk freely about their condition. In Malaysia, the main reasons for not sharing in 51 per cent of patients are the fear of being discriminated against followed by fear of having problems at work and shame or embarrassment in 46 per cent and 38 per cent, respectively.
As pDPN progresses, early diagnosis and treatment are crucial
Receiving appropriate and timely treatment for NeP is vital to help keep the underlying disease under control and improve quality of life. Overall, 58 per cent of the patients in Malaysia surveyed are taking prescription drugs, of which, 23 per cent claim to be very much or completely satisfied with their treatment, respectively. In Malaysia, other treatments being taken are dietary supplements, for 55 per cent of respondents, but also physiotherapy for 48 per cent and herbal remedies for 33 per cent. Generally, 48 per cent of the patients feel supported by their loved ones and 51 per cent have learned to live with their condition.
Despite the fact that patients claimed to be satisfied with the explanation they received about chronic pain associated with diabetes as well as the explanation about their treatment options and related outcomes, 44 per cent of patients in Malaysia still fear they will not be able to fully recover from the condition and 42 per cent feel as though they are no longer the same person as they were before. While most symptoms tend to recede over time, just under half of the patients surveyed (44 per cent) claimed they currently experience intense pain.
“At Viatris we are committed to supporting people living with painful diabetic peripheral neuropathy as the associated chronic pain significantly impacts patients’ quality of life. This is why we continue our efforts to raise awareness on the importance of early detection and access to the correct treatment as well as listen to the unmet needs and challenges that people with this condition still face today,” said Jeff Bote, Country Manager of Viatris Malaysia.
With the benefit of hindsight, one in three patients globally would have asked for advice about their symptoms sooner, not have underestimated them and explained them better to their physician. In general, in terms of the kind of support patients feel they need to have, 36 per cent in Malaysia claimed they would like to receive more information on the daily management of chronic pain associated with diabetes followed by 43 per cent needs greater awareness among the general public on the burden of chronic pain associated with diabetes and 47 per cent who needs access to psychological support.
References:
- Tesfaye S, et al., OPTION-DM trial group. Comparison of amitriptyline supplemented with pregabalin, pregabalin supplemented with amitriptyline, and duloxetine supplemented with pregabalin for the treatment of diabetic peripheral neuropathic pain (OPTION-DM): a multicentre, double-blind, randomised crossover trial. Lancet 2022; 400: 680–90 Published Online August 22, 2022 https://doi.org/10.1016/S0140-6736(22)01472-6
- ELMA Research online interview to NEP associated with diabetes sufferers’ sample in Spain, Italy, Mexico, Malaysia and South Korea, promoted by Viatris, 2023
- Jensen TS, Baron R, Haanpää M, et al. A new definition of neuropathic pain. Pain. 2011;152(10):2204-2205
- Westaway KP, Alderman CP, Frank OR, et al. Optimising therapy for patients with neuropathic pain. Journal of Pharmacy Practice and Research. 2014;44(1):44-47.
- Gore M, Dukes E, Rowbotham DJ, Tai KS, Leslie D. Clinical characteristics and pain management among patients with painful peripheral neuropathic disorders in general practice settings. Eur J Pain. 2007;11(6):652-664.
- Bouhassira D. Neuropathic pain: definition, assessment, and epidemiology. Rev Neurol (Paris). 2019;175(1-2):16-25.
- IDF Diabetes Atlas 9th edition 2019. Available on: https://www.idf.org/index.php?option=com_attachments&task=download&id=2104:WDD2019-Global-PR_Final – Accessed on Feb 2023
Source: Viatris Malaysia
