Appendix F
Neuropathic Pain
Screening Tool for Neuropathic Pain
This simple, six-item questionnaire called the ID Pain questionnaire was developed
and validated as an effective screening tool for neuropathic pain.1
Answer the following questions about your pain over the past week:
Yes Scores
Did the pain feel:
Like pins and needles
Hot or burning
Numb
Like electric shocks
Is the pain worse with touching by clothes
or bed linens?
Is the pain limited to your joints?
Total “yes” score
No Scores
1
1
1
1
1
0
0
0
0
0
−1
0
Add scores from all “yes” answers to get the total “yes” score. Scores ≥3
suggest likely neuropathic pain.
1
Portenoy R. Development and testing of a neuropathic pain screening questionnaire. ID pain.
Curr Med Res Opin 2006;22:1555–1565
D. Marcus, Chronic Pain: A Primary Care Guide to Practical Management,
© Humana Press, a part of Springer Science + Business Media, LLC 2009
423
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Appendix F Neuropathic Pain
Diabetic Neuropathy
Diabetes is the most common medical condition causing painful nerve damage,
called neuropathy. You will typically notice a burning and numbness in your feet.
Touching your feet may become unpleasant. One in every three patients with diabetes will develop neuropathy.
A number of factors increase your risk of developing diabetic neuropathy:2
●
●
●
●
●
●
●
Older age
Long duration of diabetes
Poor glucose control
Elevated cholesterol and triglycerides
Smoking
Obesity
Low physical activity
This graph shows the odds of developing a microvascular complication with diabetes,
such as neuropathy or retinopathy (nerve damage in the eye) (Fig. F.1).3 An odds ratio
number higher than 1 shows that this factor will increase your risk of developing
neuropathy or retinopathy. An odds ratio of 2 means your risk is doubled. For example, the graph shows that your risk of developing these complications is doubled if
you smoke, are inactive, and have poorly controlled blood sugars. Your risk is also
elevated if your triglyceride level is elevated.
Smoking
2.3
Low physical activity
1.7
HbA1C 8 or higher
2.0
High serum triglycerides
1.3
Long duration
2.2
Type I diabetes
2.0
Older age
1.9
0
1
2
3
Adjusted odds ratio
Fig. F.1
Risk factors for microvascular complications with diabetes (based on McClean et al.3).
2
Al-Mahroos F, Al-Roomi K. Diabetic neuropathy, foot ulceration, peripheral vascular disease and
potential risk factors among patients with diabetes in Bahrain: a nationwide primary care diabetes
clinic-based study. Ann Saudi Med 2007;27:25–31
3
McClean MT, Andrews WJ, McElnay JC. Characteristics associated with neuropathy and/or retinopathy in a hospital outpatient diabetic clinic population. Pharm World Sci 2005;27:154–158
Diabetic Neuropathy
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While you cannot do anything to reduce your risk from age or how long you
have been a diabetic, you can reduce other risk factors by doing the following:
●
●
●
●
●
Discontinue tobacco
Start or increase an aerobic exercise program
Reducing your weight
Keep your blood sugars under better control
Reducing your blood lipid levels
Controlling these factors will help reduce your risk of developing neuropathy. Also,
controlling blood sugars and other health factors can reduce the pain you experience after you have already developed diabetic neuropathy.