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Epidemiology and Impact on Quality of Life of Postherpetic Neuralgia and Painful Diabetic Neuropathy

Schmader, Kenneth E. M.D.

Special Topic Series: Neuropathic Pain
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Objective This article reviews the prevalence, risk factors, natural history, and impact on quality of life of painful diabetic neuropathy (PDN) and postherpetic neuralgia (PHN).

Discussion Diabetes mellitus afflicts more than 14 million persons in the U.S. An estimated 20% to 24% of these persons experience PDN. Data on risk factors for PDN are limited, but duration of diabetes mellitus and poor glycemic control are probably important factors. Painful diabetic neuropathy may interfere with general activity, mood, mobility, work, social relations, sleep, leisure activities, and enjoyment of life. Herpes zoster strikes an estimated 800,000 persons each year in the U.S., most of whom are elderly or immunosuppressed. Using pain at 3 months after rash onset as a definition of PHN, between 25% and 50% of adults older than 50 years develop PHN, depending on early antiviral therapy for herpes zoster. Increasing age, greater pain and rash severity, greater degree of sensory impairment, and psychological distress are risk factors for PHN. Postherpetic neuralgia may cause fatigue, insomnia, depression, anxiety, interference with social roles and leisure activity, and impaired basic and instrumental activities of daily living.

Conclusions Both conditions are common complications of their underlying disorders and can profoundly diminish the quality of life of affected persons.

Division of Geriatrics, Department of Medicine and Center for the Study of Aging, Duke University Medical Center, Durham, and Geriatric Research, Education and Clinical Center, Durham Veterans Administration Medical Center, Durham, North Carolina, U.S.A.

Received April 27, 2002; accepted April 27, 2002.

This work was supported in part by a Mid-Career Investigator Award (K24 AI51324–01) from the National Institute of Allergy and Infectious Diseases. Preparation of this article and the special section in which it appears was supported by an unrestricted educational grant from Pfizer to the University of Rochester Office of Professional Education.

Address correspondence and reprint requests to Kenneth E. Schmader, M.D., Duke University Medical Center, Center for the Study of Aging, 508 Fulton St., Durham, NC 27705, U.S.A.; e-mail: schma001@mc.duke.edu

© 2002 Lippincott Williams & Wilkins, Inc.