Changing the paradigm of peripheral neuropathy diagnosis and treatment with high-dose B-vitamins

Peripheral neuropathy (PN) is a common disease due to the damage to the peripheral nerves and is characterized by symptoms such as numbness, tingling, prickling, burning, stabbing pain, and pins-and-needles, which occur mostly in the hands and feet. Many patients are not aware of the disease because signs and symptoms often develop slowly and may be barely noticeable over long periods. Individuals at an increased risk of developing peripheral neuropathy (PN) include those with diabetes, obesity, advanced age, nutritional deficiencies, alcoholism, smokers, and undergoing chemotherapy or surgery. However, PN can also occur idiopathically, affecting younger individuals without discernible cause. Recognizing signs and symptoms of PN in high-risk groups is crucial for early diagnosis, preventing disease progression, and avoiding severe complications such as foot ulceration that may risk amputation. One of the main issues contributing to the underdiagnosis of PN is the low level of awareness among the community and the lack of routine in diagnosing PN among physicians. Several studies report that approximately 80% of patients remain undiagnosed, not only in low-income but also in high-income countries.^1-4 Therefore, raising awareness for PN in patients and helping pharmacists and primary care physicians to get the right tools to diagnose, is key to reducing the burden of PN and allowing appropriate treatment.

The central role of pharmacists in raising PN awareness and early diagnosis

Recognizing the significance of client-pharmacist relationships in expanding the advocacy for PN awareness across different healthcare specialties, P & G Health sponsored a scientific discussion during the Philippine Pharmacists Association (PPhA) Annual Convention 2024 last April 12-14 in Iloilo City. The lunch symposium was also meant to advocate for the observance of the Neuropathy Awareness Week scheduled for May 5-11, 2024. The lecture entitled “Changing the Paradigm of Peripheral Neuropathy Diagnosis and Treatment with High Dose B-Vitamins” was delivered by Dr. Kenny James Merin, a pharmacist and Assistant Vice President for Academics and Research, Lyceum of the Philippines – Davao, was attended by almost 7500 pharmacists (2500 onsite and 500 virtual) from all over the Philippines. Highlighted during the talk was the official launch of the Peripheral Neuropathy Questionnaire developed by P&G in collaboration with a panel of international specialists from different medical fields. The questionnaire aims to simplify the identification of symptoms of possible cases of PN that pharmacists may encounter and equips them with the necessary information for the proper guidance and referral of patients as appropriate. Another point emphasized during the session is the treatment of peripheral neuropathy with high doses of these neurotropic B-vitamins is not the same with other available B-vitamins in the market. Therapeutic dose of these Neurotropic B-vitamins (B1, B6, B12) is beneficial for nerve protection and pain relief in peripheral neuropathy.

Patient-administered questionnaire simplifies screening and empowers the patients

Overcoming the barrier to PN diagnosis is a key change to improve the lives of affected patients. The first step to changing the paradigm and getting patients diagnosed timely is to increase community awareness and empower patients to act and drive their journey to diagnosis. Self-diagnosis of PN is not possible, however, patients could already screen their risk factors and get a sense of their risk level.   

With the new tool, developed by a multinational expert panel, a person who notices suspicious signs or symptoms, can now screen for PN by completing a short and simple questionnaire that is intended to be easily accessible by the community in different places such as pharmacies, shoe stores, etc. After responding to 5 simple questions the patient will receive a score that indicates a certain risk level for neuropathy. The call to action for the patient is to see a physician, who can then in the second step diagnose PN with a simple diagnostic questionnaire.⁴ Thus, shifting the focus from the physician as the only one investing time and suspecting a diagnosis to the patient or community who can also screen for PN and consult a physician earlier facilitates a faster and easier diagnosis.

The expert panel identified barriers to diagnosis and developed a simple tool to conduct the diagnosis in a few minutes

We all know how crowded and busy clinics and physicians’ offices are. With a very limited amount of time, physicians need to take care of multiple health issues and often do not have time for an extensive investigation. Questionnaires for PN are generally a very helpful tool on the way to diagnosis, but validated questionnaires are often complicated and time-consuming or have complex and variable scoring systems. Therefore, a multispecialty expert panel from 11 countries developed a consensus on how the diagnosis of PN can be improved. They agreed that, among other things, ‘community awareness’ and ‘shifting the focus of control’ may significantly contribute to speeding up the diagnosis. Therefore, the first part of the new questionnaire is for the patient. Secondly, reducing the time for diagnosis for the physician and simplifying the procedure will be a step change and help physicians across the globe to diagnose peripheral neuropathy within minutes. The second part of the questionnaire guides physicians on two specific but simple sensory tests to finalize the diagnosis.⁴ Both parts come together and are a new approach to improve the diagnosis of peripheral neuropathy. 

Patients often suffer from PN symptoms for around 5 years before being diagnosed, with the new tool, this is going to change!⁴   A detailed overview of the consensus publication is now available free online and can be accessed here.