Weill Cornell Medicine-Qatar, Qatar Foundation, Doha, Qatar.
College of Medicine, De La Salle Medical and Health Science Institute, Dasmarinas, the Philippines.
J Diabetes Investig. 2020 Sep;11(5):1097-1103. doi: 10.1111/jdi.13269. Epub 2020 May 21.
Burning and stabbing pain in the feet and lower limbs can have a significant impact on the activities of daily living, including walking, climbing stairs and sleeping. Peripheral neuropathy in particular is often misdiagnosed or underdiagnosed because of a lack of awareness amongst both patients and physicians. Furthermore, crude screening tools, such as the 10-g monofilament, only detect advanced neuropathy and a normal test will lead to false reassurance of those with small fiber mediated painful neuropathy. The underestimation of peripheral neuropathy is highly prevalent in the South-East Asia region due to a lack of consensus guidance on routine screening and diagnostic pathways. Although neuropathy as a result of diabetes is the most common cause in the region, other causes due to infections (human immunodeficiency virus, hepatitis B or C virus), chronic inflammatory demyelinating polyneuropathy, drug-induced neuropathy (cancer chemotherapy, antiretrovirals and antituberculous drugs) and vitamin deficiencies (vitamin B , B , B , D) should be actively excluded.
脚部和下肢的灼烧样和刺痛样疼痛会对日常生活活动产生重大影响，包括行走、爬楼梯和睡眠。特别是外周神经病变，由于患者和医生缺乏认识，常常被误诊或漏诊。此外，简单的筛查工具，如 10g 单丝，只能检测到晚期神经病变，而正常的检测结果会导致对小纤维介导的疼痛性神经病变患者产生错误的安心感。由于对常规筛查和诊断途径缺乏共识指导，东南亚地区外周神经病变的低估非常普遍。尽管糖尿病引起的神经病变是该地区最常见的原因，但其他原因包括感染（人类免疫缺陷病毒、乙型或丙型肝炎病毒）、慢性炎症性脱髓鞘性多发性神经病、药物引起的神经病（癌症化疗、抗逆转录病毒和抗结核药物）和维生素缺乏症（维生素 B 、B 、B 、D）也应积极排除。
