Diabetic polyneuropathy is a common complication of diabetes that can be painful or non-painful.1., 2. Painful diabetic peripheral neuropathy (pDPN) results from damage or dysfunction of the neuronal system that signals pain.3 Symptoms of pDPN include burning, aching, shooting and stabbing pain, particularly in the feet and calves and less frequently in the hands.3., 4.

The European prevalence of pDPN is estimated to affect 6–34 % of people with diabetes mellitus, depending on the diagnostic criteria used.3., 5., 6. However, there is evidence that pDPN is underdiagnosed among people with neuropathic pain symptoms, limiting patients' access to prompt and appropriate treatment.7., 8., 9., 10., 11. This may be partly because healthcare professionals (HCPs) involved in the care of patients with diabetes do not always ask about or discuss pain symptoms.8 In addition, patients with pDPN can have difficulty in recognising their symptoms or are fearful of being stigmatised and may not proactively report their pain.12., 13. Patients may also have other causes of lower extremity pain in addition to their pDPN,14 complicating the diagnosis. Questionnaires such as the ‘Douleur Neuropathique en 4 Questions’ (DN4), have been developed to aid with the diagnosis of neuropathic pain.15., 16., 17. The DN4 has been validated as a screening tool for pDPN and used in surveys as a tool to screen patients with diabetes for pDPN.15., 16., 17. A recent study that utilised the DN4 to screen unselected diabetes patients for painful neuropathy found that 25 % were previously undiagnosed with pDPN, with most requiring treatment.18

pDPN can profoundly impair patients' quality of life. Pain symptoms can affect daily activities, sleep, mood19 and work productivity, with higher pain severity associated with a greater patient burden.3 Treatment approaches include non-pharmacological and pharmacological options; currently recommended pharmacological treatments include oral (such as antidepressants and anticonvulsants) and topical medications.8., 20., 21.

Improving HCPs' understanding of pDPN and its impact on patients is likely to be important for enhancing patient−HCP communication around pain, thereby increasing rates of diagnosis, improving treatment, and enhancing patient satisfaction.7., 22. This study was based on an online questionnaire completed by patients in four European countries. The aim was to assess the personal impact of pDPN, examine how the patient–HCP relationship affects the patient experience, and identify solutions for improving the management of pDPN.