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Neuropathy very common, but underdiagnosed, study says
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1 of 2 | "Neuropathy is a painful, disabling condition for many people
who have it. It affects their, their overall quality of life and often
leads to depression," said the study's lead author, Dr. Melissa
Elafros, an assistant professor of neurology at the University of
Michigan Medical School. Photo by Douglas Pike/Hurley Medical Center
NEW YORK, May 8 (UPI) -- Neuropathy -- nerve damage that causes pain,
numbness, weakness or tingling in the feet and hands -- is very common
and underdiagnosed, a new study indicates.
The study, conducted through a partnership between the University of
Michigan in Ann Arbor and Hurley Medical Center in Flint, was
published Wednesday in Neurology, the medical journal of the American
Academy of Neurology.
In some cases, neuropathy can eventually lead to falls, infections and
even amputations, the study's authors noted.
"Neuropathy is a painful, disabling condition for many people who have
it. It affects their sleep, their overall quality of life and often
leads to depression," said the study's lead author, Dr. Melissa
Elafros, an assistant professor of neurology at the University of
Michigan Medical School.
"Unfortunately, there is no disease-modifying treatment for neuropathy
-- meaning the best that we can do for many people is trying to
decrease their pain and prevent falls or infections from injury to
their feet," Elafros said.
Researchers assessed 169 people from an outpatient internal medicine
clinic that serves primarily Medicaid patients in Flint, Mich. The
participants, with an average age of 58, were 69% Black.
"Minority and low-income communities are often under-represented in
clinical research," Elafros said, noting that "currently, the accepted
prevalence rate for neuropathy is 13.5%. Yet, in our population, it
was 73%."
Fewer than 20% of people with neuropathy were aware of their
condition.
"This is a big problem because that means they are likely not doing
the things that can prevent falls, infections and even eventual
amputations," Elafros said.
One-half of those studied had diabetes, which can injure nerves
throughout the body and result in neuropathy.
A total of 67% had metabolic syndrome -- defined by the presence of
excess belly fat plus two or more of the following risk factors
associated with neuropathy: high blood pressure, higher than normal
triglycerides, high blood sugar and a low level of high-density
lipoprotein cholesterol, or "good" cholesterol.
A total of 73% of participants had neuropathy. Of these people, 75%
had not been previously diagnosed. Almost 60% of those with neuropathy
were experiencing pain. Of those with neuropathy, 74% had metabolic
syndrome, compared to 54% of those who did not have it.
After adjusting for other variables that could impact the risk of
neuropathy, researchers found that people with metabolic syndrome were
over four times more likely to have neuropathy than people without the
syndrome.
"The big takeaway message of this work is that neuropathy is likely
more common than we think," Elafros said. "By underdiagnosing
neuropathy, we miss a valuable opportunity to counsel patients to
improve their well-being."
Researchers also explored any connection between race and income and
neuropathy, as few studies have delved into those issues. There was no
link between low income and neuropathy.
Black people had a lower risk of neuropathy. They comprised 60% of
participants with neuropathy and 91% of those without the condition.
The study was a joint effort between providers at Hurley Medical
Center in Flint and researchers from the University of Michigan.
"One thing that I learned was how hard it can be to screen for
neuropathy in a busy primary care clinic," Elafros said. "Our team is
capitalizing on this collaboration to help improve care for neurologic
diseases in places like Flint."
She added that "this study is just a snapshot in time at one clinic in
Flint. It does not tell us how quickly people develop neuropathy in
this clinic." In addition, it may not represent other parts of the
city.
The study received support from the National Institute of Neurological
Disorders and Stroke, National Institute of Diabetes and Digestive and
Kidney Diseases and National Center for Advancing Translational
Sciences.
"It's an outstanding study and really important. Peripheral neuropathy
is a widespread problem in the U.S. population," said Dr. David
Herrmann, a professor of neurology and pathology at the University of
Rochester Medical Center in Rochester, N.Y., who was not involved in
the research.
As many as 10% of people will develop neuropathy in their lifetime.
This study suggests that peripheral neuropathy is even more frequent
in minority and underserved groups, Hermann said.
The study presents an "incredible opportunity" to raise awareness that
neuropathy is "a common consequence" of metabolic syndrome, including
diabetes, obesity, abnormal blood lipids and high blood pressure, he
said, adding that "this is clearly a public crisis."
Neuropathy is under-diagnosed because "symptoms often start off
quietly in the background -- a little numbness or tingling in the
feet, a little difficulty wiggling the toes, some trouble with balance
or unexplained falls," said Dr. Maxwell Levy, an assistant professor
of neurology and associate residency program director at Tulane
University School of Medicine in New Orleans.
"However, it can progress over months to years to be more disruptive
and disabling. People should be sure to bring these symptoms to their
doctor's attention, so they can be screened for medical conditions
that cause neuropathy," Levy said.
"There is no single blood test or imaging study that will diagnose
neuropathy. A neurologist can perform a nerve conduction test to
further characterize the subtype of a neuropathy or can determine if
neuropathy is present in uncertain cases," he said.
It's important to diagnose and treat neuropathy appropriately as early
in the condition's course as possible, said Dr. Vishakhadatta Mathur
Kumaraswamy, an assistant professor of neurology and neuromuscular
medicine at the University of Kentucky College of Medicine in
Lexington.
"Delay in treatment of the underlying cause of neuropathy may lead to
poorer outcomes in the form of incomplete recovery or permanent
disability from weakness or gait imbalance," Kumaraswamy said. "It
also increases the chances of potentially preventable complications,
such as falls, joint deformities and nonhealing wounds."
The high prevalence of diabetes and metabolic syndrome in the study
may not be completely representative of the patient population, said
Dr. Ashley Weng, an assistant professor of neurology at Rutgers Robert
Wood Johnson Medical School in New Brunswick, N.J.
Participants were selected when they came to the clinic for routine
care, so the study may skew toward sicker patients who seek help, Weng
said. Also, she noted, "It is possible that those with symptoms of
neuropathy were more interested in participating."
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