There are clear published guidelines for the best way to diagnose peripheral neuropathy. However, a new study examining Medicare data found that neurologists and other doctors often order expensive, unnecessary tests to diagnose it.
The guidelines for diagnosing peripheral neuropathy were published in 2009 and last updated in 2017. But, even though they have been established for over a decade, they are often ignored. The guidelines recommend against using MRIs or electrodiagnostic testing (EMG). Those tests don’t alter treatment plans and aren’t the most reliable for diagnosing neuropathy. However, MRIs are used 25.7 percent of the time, and EMGs are used 22.6 percent.
According to the guidelines and experts, the best tests for peripheral neuropathy are simple and inexpensive blood tests for B12 levels and serum protein electrophoresis (SPEP). But, only 8.3 percent of doctors check B12 levels and 13.4 percent use SPEP. Not only are doctors using the less effective tests, but they are doing so more frequently. Since 2009, EMGs have increased by 2.8 percent, and MRIs have increased by 2.6 percent.
While the lead author, Dr. Brian Callaghan, was disappointed, he wasn’t surprised. “Guidelines often aren’t followed and it’s difficult to change doctors’ behavior. We need to be more prudent in who we decide to test and the type of tests we order.”
Previously, Dr. Callagham led a study looking at Medicare data from 1998 to 2007. That work found that b12 levels, glucose tolerance test and SPEP weren’t used frequently enough while MRIs and EMGs were overutilized. They performed this study to see if things had changed for the better.
Reviewers of the study said they hope this changes the way the guidelines are promoted. The guidelines themselves are correct. But Doctors aren’t following them. If the information were presented in webinars, infographics or pop-up prompts in e-medical records, it could change how doctors who are set in their ways behave.
“Current practice leads to too many EMG and MRI studies that are costly and do not improve the lives of patients with peripheral neuropathy,” said Dr. Callaghan. “While at the same time, not enough simple blood tests are ordered to determine the cause of this condition. Recommendations and time are not enough to improve our practice. Instead, interventions are needed to encourage optimal care.”
Simpler, less expensive tests can be more beneficial to patients. If you have been struggling with nerve pain or numbness and your doctor suggests an MRI or EMG to check for neuropathy, discuss a B12 test and SPEP instead. Remember, you are always your first and best advocate and are in charge of deciding what tests to get. You and your doctor can discuss your options to make a plan that would help you the most without expensive, unnecessary tests.
