Table 1.
Expert consensus recommendations for community pharmacists in peripheral neuropathy management.
| No | Consensus statement | % Agreement |
|---|---|---|
| 1 | The goals of DPN treatment are (1) to reduce DPN symptoms and its impact on QoL, (2) to prevent or control DPN complications, (3) to minimise adverse reactions from DPN treatments, and (4) to promote patients’ understanding and adherence to the treatment plan. | 100 |
| 2 | The initial evaluation of DPN can be done by | 100 |
| 2.1 | Gathering medical histories, such as duration of symptoms, alcohol consumption, underlying diseases especially diabetes, hypertension, hypothyroidism/hyperthyroidism, cardiovascular diseases, dyslipidemia, chronic kidney disease, obesity, and duration of diabetes. | |
| 2.2 | Inquiring about concomitant medications (such as metformin, antacids and proton pump inhibitors), food supplements (such as vitamin B) and the patient’s dietary patterns. | 83.3 |
| 2.3 | Querying about symptoms of DPN including lancinating, paresthaesia, tingling, numbness, electric shock-like sensations, burning, cold allodynia, itching and timing of the symptoms. Such symptoms may occur on both sides of the body (symmetrical) | 100 |
| 2.4 | The Douleur Neuropathique 4 Questions (DN4) interview or the 7-item version of the DN4 questionnaire with a cut-off of 3 may be used for screening painful DPN. If the DN4 score is less than 3, advise patients to see a physician in case of severe pain (NRS = 7–10) or if it impacts their QoL. | 83.3 |
| 2.5 | A simple screening tool for loss of protective sensation (LOPS) is the monofilament test. | 100 |
| 2.6 | If patients have symptoms including weakness, foot drop, hand and/or foot atrophy, and unilateral numbness, they should be advised to consult a doctor to determine more possible causes. | 100 |
| 3 | If DPN is suspected after evaluation regarding consensus statement 2 such as duration of numbness of more than three months with underlying diseases and/or current use of the drug in 2.1 and 2.2, the total symptom score of DN4 is three or more points, and inability to express tactile perception in the monofilament test. A combination of neurotropic B vitamins can be used in therapeutic doses (therapeutic doses of vitamin B1 100–600 mg/day, vitamin B6 100–600 mg/day, vitamin B12 400–5000 mcg/day) by | 100 |
| 3.1 | Monotherapy of a combination of neurotropic B vitamins or | 83.3 |
| 3.2 | In combination with other drugs, such as SNRI, TCA, topical treatment, and alpha-2 delta subunit calcium channel blocker antiseizure medications. | 83.3 |
| 4 | Combined neurotropic B vitamins have synergistic effect and improve patient compliance. | 83.3 |
| 5 | Advise patients on pharmacological and non-pharmacological approaches and take medication regularly. | 100 |
| 5.1 | Patients are advised to self-assess their symptoms after the first 2 weeks of taking a combination of neurotropic B vitamins. If the symptoms do not improve or patients experience intolerant side effects, it is advised to consult a physician for further investigation. | 83.3 |
| 5.2 | Minimise the risk of neurotropic B vitamin deficiency, including avoidance of foods that interfere with the absorption of B vitamins and regular screening for B12 deficiency and supplementation of B12 among strict vegetarians. | 83.3 |