Very common, but underdiagnosed neuropathy, study finds

1 of 2 | “Neuropathy is a painful and debilitating condition for many people who suffer from it. This affects their overall quality of life and often leads to depression,” said study lead author Dr. Melissa Elafros, assistant professor of neurology at the University of Michigan Medical School. Photo by Douglas Pike/Hurley Medical Center

In some cases, neuropathy can eventually lead to falls, infections and even amputations, the study authors note.

“Neuropathy is a painful and debilitating condition for many people who suffer from it. It affects their sleep, their overall quality of life and often leads to depression,” said lead study author Dr. Melissa Elafros. , assistant professor of neurology at the university. University of Michigan Medical School.

“Unfortunately, there is no cure for neuropathy – which means the best we can do for many people is to try to reduce their pain and prevent falls or infections from injuries to their hands. feet,” Elafros said.

Researchers evaluated 169 people from an outpatient internal medicine clinic that primarily serves Medicaid patients in Flint, Michigan. Participants, with an average age of 58, were 69% black.

“Minority and low-income communities are often underrepresented in clinical research,” Elafros said, noting that “currently, the accepted prevalence rate of neuropathy is 13.5%. Yet in our population, it was 73%.”

Less than 20% of people with neuropathy were aware of their condition.

“It’s a big problem because it means they’re probably not doing the things that can prevent falls, infections and even possible amputations,” Elafros said.

Half of the people studied had diabetes, which can damage nerves throughout the body and lead to neuropathy.

A total of 67% had metabolic syndrome, defined by the presence of excess abdominal fat and two or more of the following risk factors associated with neuropathy: high blood pressure, higher than normal triglyceride levels, sugar levels in high blood and low rate of hyperglycemia. density lipoprotein cholesterol, or “good” cholesterol.

In total, 73% of participants suffered from neuropathy. Of these people, 75% had never been diagnosed before. Nearly 60% of people with neuropathy experienced pain. Among people with neuropathy, 74% had metabolic syndrome, compared to 54% of those without it.

After adjusting for other variables that may impact neuropathy risk, researchers found that people with metabolic syndrome were four times more likely to have neuropathy than people without the syndrome.

“The big take-home message from this work is that neuropathy is probably more common than we think,” Elafros said. “By underdiagnosing neuropathy, we are missing a valuable opportunity to counsel patients to improve their well-being.”

Researchers also explored any links between race, income and neuropathy, as few studies have looked at these issues. There was no association between low income and neuropathy.

Black people had a lower risk of neuropathy. They represented 60% of participants with neuropathy and 91% of those without it.

The study is a joint effort between providers at Hurley Medical Center in Flint and researchers at the University of Michigan.

“One thing I learned is how difficult 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 neurological diseases in places like Flint. »

She added that “this study is just a snapshot in one clinic in Flint. It doesn’t tell us how quickly people develop neuropathy in this clinic.” Additionally, it may not represent other parts of the city.

The study received support from the National Institute of Neurological Disorders and Stroke, the National Institute of Diabetes and Digestive and Kidney Diseases, and the National Center for Advancing Translational Sciences.

“This is an exceptional and really important study. Peripheral neuropathy is a widespread problem in the American population,” said Dr. David Herrmann, professor of neurology and pathology at the University of Rochester Medical Center, Rochester, in New York State, which did not participate in the study. the research.

Up to 10% of people will develop neuropathy in their lifetime. This study suggests that peripheral neuropathy is even more common 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 underdiagnosed because “symptoms often start quietly in the background – a little numbness or tingling in the feet, a little difficulty wiggling your toes, balance problems or unexplained falls,” said the Dr. Maxwell Levy, an assistant. professor of neurology and associate director of the residency program at Tulane University School of Medicine in New Orleans.

“However, this can progress over months or even years to become more disruptive and disabling. People should be sure to bring these symptoms to the attention of their doctor, so they can be screened for conditions causes neuropathy,” Levy said.

“There is no single blood test or imaging study that can diagnose neuropathy. A neurologist may perform a nerve conduction test to further characterize the subtype of a neuropathy or determine if neuropathy is present in uncertain cases,” he said.

It is important to diagnose and treat neuropathy appropriately as early as possible in the course of the disease, said Dr. Vishakhadatta Mathur Kumaraswamy, assistant professor of neurology and neuromuscular medicine at the University’s Faculty of Medicine. from Kentucky to Lexington.

“Delay in treating the underlying cause of neuropathy can lead to poorer outcomes in the form of incomplete recovery or permanent disability due to gait weakness or imbalance,” said Kumaraswamy. “It also increases the risk of potentially preventable complications, such as falls, joint deformities and non-healing wounds.”

The high prevalence of diabetes and metabolic syndrome in the study may not be completely representative of the patient population, Dr. Ashley Weng, assistant professor of neurology at Rutgers Robert Wood Johnson School of Medicine, told New. -Brunswick, New Jersey.

Participants were selected when they came to the clinic for routine care, so the study could focus on the sickest patients seeking help, Weng said. Additionally, she noted, “it is possible that those with symptoms of neuropathy may be more interested in participating.”