[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"doc-seo-416743-105":3,"doc-detail-416743-en":81,"detail-sidebar-cat-0-en-105":97},{"code":4,"msg":5,"data":6},0,"ok",{"site_id":7,"language":8,"slug":9,"title":10,"keywords":11,"description":12,"schema_data":13,"social_meta":74,"head_meta":76,"extra_data":78,"updated_unix":80},105,"en","letter-to-the-editor-filipe-jose-ribeiro-antunes","Letter to the Editor - Filipe José Ribeiro Antunes","","Letter to the editor addressing observations and outcomes from an initial observational study in Portuguese primary care units focused on pain burden in the DPN diabetic population. The author thanks the previous letter, explains use of DN4 for pain characterization, and discusses literacy improvements and the role of lifestyle changes. Limitations related to healthcare professional participation and consultation time are emphasized, alongside EQ-5D-5L findings and the need for structured, multidisciplinary pain programs including psychological professionals.",{"@graph":14,"@context":73},[15,34,56],{"@type":16,"itemListElement":17},"BreadcrumbList",[18,23,27,31],{"item":19,"name":20,"@type":21,"position":22},"https://docshare.wps.com","Home","ListItem",1,{"item":24,"name":25,"@type":21,"position":26},"https://docshare.wps.com/document/","Document",2,{"item":28,"name":29,"@type":21,"position":30},"https://docshare.wps.com/document/healthcare/","Healthcare",3,{"item":32,"name":10,"@type":21,"position":33},"https://docshare.wps.com/document/letter-to-the-editor-filipe-jose-ribeiro-antunes/416743/",4,{"url":32,"name":10,"@type":35,"image":36,"author":41,"headline":10,"publisher":44,"fileFormat":47,"inLanguage":8,"description":12,"dateModified":48,"datePublished":49,"encodingFormat":47,"isAccessibleForFree":50,"interactionStatistic":51},"DigitalDocument",{"url":37,"@type":38,"width":39,"height":40},"https://docshare.wps.com/thumbnails/letter-to-the-editor-filipe-jose-ribeiro-antunes/416743.png","ImageObject",300,407,{"name":42,"@type":43},"Muffet","Person",{"url":19,"name":45,"@type":46},"DocShare","Organization","application/pdf","2026-10-30","2026-09-28",true,{"@type":52,"interactionType":53,"userInteractionCount":55},"InteractionCounter",{"@type":54},"ViewAction",14,{"@type":57,"mainEntity":58},"FAQPage",[59,65,69],{"name":60,"@type":61,"acceptedAnswer":62},"What is the main purpose of this letter to the editor?","Question",{"text":63,"@type":64},"To thank the authors for the letter and to respond to observations, focusing on the importance of pain in the DPN diabetic population in Portuguese primary care.","Answer",{"name":66,"@type":61,"acceptedAnswer":67},"How was pain characterized in the study?",{"text":68,"@type":64},"Pain was assessed and classified using the DN4 questionnaire, with many participants scoring 4 or more points.",{"name":70,"@type":61,"acceptedAnswer":71},"What limitations does the author highlight?",{"text":72,"@type":64},"The letter emphasizes limitations related to participation of healthcare professionals and the limited consultation time and protocol constraints in routine primary care settings.","https://schema.org",{"og:url":32,"og:type":75,"og:title":10,"og:site_name":45,"og:description":12},"article",{"robots":77,"canonical":32},"index,follow",{"doc_id":79,"site_id":7},416743,1790812215,{"code":4,"msg":82,"data":83},"success",{"doc_id":79,"user_id":84,"nickname":42,"user_avatar":85,"doc_module":4,"category_id":86,"category_name":29,"doc_title":10,"doc_description":12,"doc_content":87,"file_id":88,"file_url":89,"file_type":90,"file_size":91,"view_count":55,"is_deleted":4,"is_public":22,"is_downloadable":22,"audit_status":22,"page_count":22,"language":92,"language_code":8,"site_id":7,"html_lang":8,"table_of_contents":93,"faqs":94,"seo_title":95,"seo_description":12,"update_tm":96,"read_time":30,"preview_page_count":4},962090768927,"https://ap-avatar.wpscdn.com/davatar_085a072bc5b1113ac321206ff7593b45",7,"Future Science OA  \n2026, VOL. 12, nO. 1, 2606366  \n[https://doi.org/10.1080/20565623.2025.2606366](https://doi.org/10.1080/20565623.2025.2606366)  \nLETTER TO THE EDITOR  \nFilipe José Ribeiro Antunes  \nPhysical and rehabilitation Medicine Department and chronic Pain Functional unit, Braga Hospital, Braga, Portugal  \nI would like to thank you the letter and the possibility of trying to answer the kind observations made in this letter to the editor.  \nThis was the first observational study made in primary care units (PCU) to understand the importance of pain in the DPN population. The study was conducted by primary care physicians in their own PCU with the population of diabetic patients  \n77.5% of this population (known already as diabetic patients) signalized the doctor that they had pain at baseline. To try to understand and classify this reported pain, we used the DN4 and 48.3% pointed 4 or more points. We must signalize that we were in Portuguese PCU with limited tools to clarify this result and the rationale of doing this study was to understand the burden of pain in PCU in a normal and scheduled consultation, with this kind of known population.  \nWe agree with the observation that some kind of improvement in literacy was reached, particularly with some positive lifestyle changes, a very important issue in an old population, in PCU, in Portugal, but the importance of the physical exercise remains a unknown and important preventive clinical (analgesic, anti-inflammatory, diabetic,…) tool.  \nWe also agree with the pointed limitations, particularly that concerned to participation of healthcare professionals. The study was conducted in the normal ambience of PCU with limited time to do the consultation and the study protocol. This was one of the most surprising results and probably one of the most important reasons of the global results of the study, mainly the result of the prevalence of pain, the EQ-5D-5L results and even the result of patient’s literacy.  \nOf course, we can argue that the results of the study, nevertheless the EQ-5D-5L, was suboptimal and probably explained by the kind of population, old, with no literacy, in primary care consultations in Portugal, but it was not a surprise to the authors.  \nIn this kind of Portuguese settings, it is not current to do this kind of studies and not frequent to evaluate the cognitive status in objective measures/questionnaires, but of course we agree that is of most relevance.  \nWith this study, we believe we have pointed the importance of pain in Portuguese primary care settings, mainly with the prevalence of pain in this population.  \nWe hope to show the need of structured programs to combat pain, a sensitive and emotional condition, mainly the necessity of psychological professionals in all clinical settings as an obvious added value in the multidimensional pain management.  \nCONTACT Filipe José ribeiro Antunes  [filipe.j.antunes@gmail.com](filipe.j.antunes@gmail.com)  Physical and rehabilitation Medicine Department and chronic Pain Functional unit, Braga Hospital, Braga, Portugal  \n© 2025 the Author(s) . Published by informa uK Limited, trading as taylor & Francis Group  \nthis is an Open Access article distributed under the terms of the creative commons Attribution-noncommercial License ([http://creativecommons.org/licenses/by-nc/4.0/](http://creativecommons.org/licenses/by-nc/4.0/)), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. the terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.","cbCaijNJNMaJRrs1","https://ap.wps.com/l/cbCaijNJNMaJRrs1","pdf",167833,"English","# Letter to the Editor\n## Background and study purpose\n## Pain assessment with DN4\n## Literacy, lifestyle changes, and exercise\n## Limitations and outcome discussion\n## Conclusion and call for structured programs","[{\"question\":\"What is the main purpose of this letter to the editor?\",\"answer\":\"To thank the authors for the letter and to respond to observations, focusing on the importance of pain in the DPN diabetic population in Portuguese primary care.\"},{\"question\":\"How was pain characterized in the study?\",\"answer\":\"Pain was assessed and classified using the DN4 questionnaire, with many participants scoring 4 or more points.\"},{\"question\":\"What limitations does the author highlight?\",\"answer\":\"The letter emphasizes limitations related to participation of healthcare professionals and the limited consultation time and protocol constraints in routine primary care settings.\"}]","Letter to the Editor - Filipe José Ribeiro Antunes | PDF",1790606526,{"code":4,"msg":82,"data":98},[99,103,107,111,116,121,124,129,134,137,141],{"id":22,"doc_module":4,"doc_module_name":25,"category_name":100,"show_sort_weight":101,"slug":102},"Story & Novel",90,"story-novel",{"id":26,"doc_module":4,"doc_module_name":25,"category_name":104,"show_sort_weight":105,"slug":106},"Literature",80,"literature",{"id":33,"doc_module":4,"doc_module_name":25,"category_name":108,"show_sort_weight":109,"slug":110},"Exam",70,"exam",{"id":112,"doc_module":4,"doc_module_name":25,"category_name":113,"show_sort_weight":114,"slug":115},5,"Comic",60,"comic",{"id":117,"doc_module":4,"doc_module_name":25,"category_name":118,"show_sort_weight":119,"slug":120},6,"Technology",50,"technology",{"id":86,"doc_module":4,"doc_module_name":25,"category_name":29,"show_sort_weight":122,"slug":123},40,"healthcare",{"id":125,"doc_module":4,"doc_module_name":25,"category_name":126,"show_sort_weight":127,"slug":128},8,"Research & Report",30,"research-report",{"id":130,"doc_module":4,"doc_module_name":25,"category_name":131,"show_sort_weight":132,"slug":133},9,"Religion & Spirituality",20,"religion-spirituality",{"id":132,"doc_module":4,"doc_module_name":25,"category_name":135,"show_sort_weight":132,"slug":136},"World Cup","world-cup",{"id":138,"doc_module":4,"doc_module_name":25,"category_name":139,"show_sort_weight":138,"slug":140},10,"Lifestyle","lifestyle",{"id":142,"doc_module":4,"doc_module_name":25,"category_name":143,"show_sort_weight":112,"slug":144},19,"General","general"]