Epidemiological data on Painful diabetic peripheral neuropathy (PDPN) is scarce in Kuwait. We aimed to study the prevalence of PDPN among diabetic patients and to assess its treatment modalities in Kuwait. This cross-sectional study collected data from 5 clinics in the primary, secondary and tertiary centres. Diabetic patients aged >18 years were included. PDPN was diagnosed based on combination of history of typical pain in extremities and objective neurological examination. Socio-demographic data and treatment modalities were extracted from the medical records. Questionnaires of patients` and practitioners` perceptions were collected from patients` and care health providers respectively. Descriptive and chi-square analyses were used to measure the statistical significance.A total of 202 diabetic participants; 109 were diagnosed as PDPN, representing a prevalence of 53.9% [95% confidence interval (CI), 50.7% – 58.5%] of the studied sample. The PDPN cohort had a mean age of 52.77±12.2 years. Patients with PDPN were older (39.6% versus 21.3%; p <0.005), taller (37.1% versus 23.8%; P <0.013), had longer disease duration (35.1% versus 21.8%; P <0.011), had body mass index > 30 (42.6% versus 26.2%; P <0.001) and higher fasting blood glucose (29.7% versus 18.8%; P <0.044) compared with patients without PDPN. The most commonly prescribed pain treatments were Non-steroidal anti-inflammatory drugs (25.68%) and anticonvulsants (22.93%).We concluded thatdisease duration, poor glycemic control and high BMI were associated with increased risk of PDPN. Patient education and management of neuropathic pain control need to be optimized.

Keywords: Painful Peripheral neuropathy, Diabetes mellitus, Kuwait.

1. Fernandez VE, Abdi S. Painful diabetic peripheral neuropathy.In: Smith H, editor. Current therapy in pain. 1st ed. Philadelphia:Saunders; 2009. 250–255.
2. Tsuji M, Yasuda T, Kaneto H, Matsuoka T, Hirose T, Kawamori R, Iseki M, Shimomura I, Shibata M. Painful Diabetic Neuropathy in Japanese Diabetic Patients Is Common but Underrecognized. Pain Research and Treatment 2013; Article ID 318352, 3 pages.
3. Taheri A , Farbood A, Heshmat R, Samadi A, Khashayar P, Qorbani M, Ghorbani M, Khaneqah G E. The effect of transdermal nitroglycerin on pain control in diabetic patients with peripheral neuropathy. Journal of Diabetes & Metabolic Disorders 2015; 14:86.
4. Veves A, Backonja M, Malik RA: Painful diabetic neuropathy: epidemiology, natural history, early diagnosis, and treatment options. Pain Med 2008; 9:660–674.
5. Bril V, England J, Franklin GM, Backonja M, Cohen J, Del Toro D, et al. Evidence-based guideline: treatment of painful diabetic neuropathy: report of the American academy of neurology, the American association of neuromuscular and electrodiagnostic medicine, and the American academy of physical medicine and rehabilitation. Neurology 2011;76(20): 1758–65.
6. Kamei N, Yamane K, Nakanishi S, Yamashita Y, Tamura T, et al. Effectiveness of Semmes-Weinstein monofilament examination for diabetic peripheral neuropathy screening. J Diabetes Complications 2005;19: 47–53.
7. Boulton AJM, Armstrong DG, Albert SF, Frykberg RG, Hellman R, et al. Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists. Diabetes Care 2008; 31: 1679–1685.
8. Bracewell N, Game F, Jeffcoate W, Scammell BE. Clinical evaluation of a new device in the assessment of peripheral sensory neuropathy in diabetes. Diabet Med 2012; 29: 1553–1555.
9. Krause SJ, and Backonja MM. Develop-ment of a neuropathic pain questionnaire. Clinical Journal of Pain 2003; 19(5) pp.306-14.
10. Possidente J, and Tandan R . A survey of treatment practices in diabetic peripheral neuropathy.Primary Care Diabetes2009;3: 253–257.
11. World Health Organization (2000) Obesity: preventing and managing the global epidemic. World Health Organization technical report series 894.
12. Jambart S, Ammache Z, Haddad F, Younes A, Hassoun A, et al.Prevalence of painful diabetic peripheral neuropathy among patients with diabetes mellitus in the Middle East region. J Int Med Res 2011; 39: 366–377.
13. Halawa MR, Karawagh A, Zeidan A, Mahmoud AE, Sakr M, et al. Prevalence of painful diabetic peripheral neuropathy among patients suffering from diabetes mellitus in Saudi Arabia. Curr Med Res Opin 2010; 26: 337–343.
14. Daousi C, MacFarlane I A, Woodward A, Nurmikkot TJ, Bundred PE, and Benbow SJ, “Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes,” Diabetic Medicine 2004;(21): 9, 976–982.
15. Davies M, Brophy S, Williams R, and Taylor A, “The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes,” Diabetes Care 2006;(29): 7; 1518–1522.
16. van Acker K, Bouhassira D, de Bacquer Det al., “Prevalence and impact on quality of life of peripheral neuropathy with or without neuropathic pain in type 1 and type 2 diabetic patients attending hospital outpatients clinics,” Diabetes and Metabolism 2009;(35): 3, 206–213.
17. Erbas T, Ertas M, Yucel A, Keskinaslan A, and Senocak M, “Prevalence of peripheral neuropathy and painful peripheral neuropathy in Turkish diabetic patients,” Journal of Clinical Neurophysiology 2011; (28): 1,51–55.
18. Harris M, Eastman R, Cowie C: Symptoms of sensory neuropathy in adults with NIDDM in the U.S. population. Diabetes Care 1993; 16:1446 – 1452.
19. Youssef AA, El Mahalli AA, Akl OA et al:Quality of diabetes care in primary care setting in Egypt: an example of health sector reform in developing countries. J Egypt Public Health Assoc 2006; 81: 301 – 320.
20. Al-Elq AH: Current practice in the management of patients with type 2 diabetes mellitus in Saudi Arabia. Saudi Med J 2009; 30: 1551 –1556.
21. Morkrid K, Ali L, Hussain A. Risk factors and prevalence of diabetic peripheral neuropathy: A study of type 2 diabetic outpatients in Bangladesh. Int J Diabetes Dev Ctries 2010; 30: 11–17.
22. Dyck PJ, Davies JL, Clark VM, Litchy WJ, Klein CJ, et al. Modeling chronic glycemic exposure variables as correlates and predictors of microvascular complications of diabetes. Diabetes Care 2006; 29: 2282-2288.
23. De Block CE, De Leeuw IH, Van Gaal LF. Impact of overweight on chronic microvascular complications in type 1 diabetic patients. Diabetes Care2005; 28: 1649–1655.
24. Themistocleousa AC, Ramireza JD, Shillob PR, Leesc JG, Selvarajahb D, Orengoc C, Tesfayeb S, Andrew S.C. Riced ASC, Bennetta DLH. The Pain in Neuropathy Study (PiNS):a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy. Pain 2016; (157): 5, 1132-45.
25. National Pain Foundation (NPF) and Eli Lilly and Company.(2007) Talk beyond pain: Understanding diabetic nerve pain. [internet] 2007. Available at: http://www.news-medical.net/news/2007/04/20/23947.aspx [Accessed 12/05/2011].
26. Moulin DE, Clark AJ, Gilron I, et al: Pharmacological management of chronic neuropathic pain – consensus statement and guidelines from the Canadian Pain Society. Pain Res Manag 2007; 12: 13 – 21.
27. Bohlega S, Alsaadi T, Amir A, et al: Guidelines for the pharmacological treatment of peripheral neuropathic pain: expert panel recommendations for the Middle East region. J Int Med Res 2010; 38: 295 – 317.
28. Ziegler, D.Treatment of diabetic neuropathy and neuropathic pain: how far have we come.? Diabetes Care2008; S255-61.
29. Galer BS, Gianas A and Jensen MP. Painful diabetic polyneuropathy: epidemi-ology, pain description, and quality of life.Diabetes Research and clinical practice. 2000; 47:(2),123-8.

Samar Farouk Ahmad

Department of Neurology, Ibn Sina Hospital, P.O. Box 25427, Safat 13115, Kuwait

Department of Neurology and Psychiatry, Al Minia University, Faculty of Medicine, P.O. Box 61519, Minia 61111, Egypt

Email: This email address is being protected from spambots. You need JavaScript enabled to view it.