Diabetic Peripheral Neuropathic Pain in the Middle East: Epidemiology, Burden, and Contemporary Management Strategies

The Middle East and North Africa region bears the world’s highest diabetes burden, with prevalence rates of 16.2%–24.9% substantially exceeding the global average. Diabetic peripheral neuropathic pain (DPNP) affects 37%–65% of diabetic patients across the region, yet remains systematically underdiagnosed, with recognition rates below 50% in routine clinical practice. This narrative review synthesizes current evidence on DPNP epidemiology, burden, and management within the Middle Eastern context. A comprehensive literature search was conducted using PubMed, Scopus, and regional databases, focusing on studies published between 2000 and 2025 that examined diabetes, diabetic neuropathy, and neuropathic pain in Middle Eastern populations. Search terms included combinations of diabetes mellitus, diabetic neuropathy, neuropathic pain, prevalence, treatment, and country-specific terms. The review identified substantial geographic variation in painful neuropathy prevalence, ranging from 37.1% in Gulf Cooperation Council states to 61.3% in Egypt. Risk factors include prolonged diabetes duration, poor glycemic control, obesity, and genetic susceptibility. The condition profoundly impairs quality of life, with patients demonstrating significantly lower physical and mental health scores compared to diabetic patients without neuropathic pain. First-line pharmacological treatments, including pregabalin, duloxetine, and tricyclic antidepressants, demonstrate comparable efficacy, with treatment selection guided by comorbidities and tolerability. Emerging therapies such as high-concentration capsaicin patches and spinal cord stimulation offer promise for refractory cases. Unique regional challenges include cultural factors affecting pain expression, religious considerations during Ramadan, and healthcare system fragmentation. However, diabetes complications, including neuropathy, are universal across all populations and require consistent evidence-based treatment regardless of cultural context. Improving outcomes requires systematic screening implementation, medication adherence support, and region-specific clinical research. This review provides evidence-based recommendations for clinicians while identifying critical research priorities to address the substantial unmet needs of Middle Eastern patients with DPNP.