Caring for the Hands That Care: Highlights from the Neuropathy Awareness Week
21 Sep 2026
The Hidden Burden: Peripheral Neuropathy in the Filipino Elderly
Peripheral neuropathy (PN) refers to damage to the peripheral nerves, the network that carries signals between the central nervous system and the body, including the hands, feet, and internal organs. In elderly populations, its burden is far greater than commonly recognized.
Research estimates that nearly 1 in 5 elderly adults (18.9%) may be living with PN, particularly those over 60 years of age.1 Yet many silently endure their symptoms – numbness, tingling, weakness, and discomfort – attributing them to aging rather than to an underlying condition that warrants specific care.2
The consequences of inaction are significant. PN is an independent risk factor for falls in older adults, with downstream effects on mobility, independence, and survival.2-4 One cohort study found that elderly patients with detectable PN had a mean survival time approximately three years shorter than those without the condition.5 These figures underscore the urgency of moving from passive acceptance to proactive clinical recognition.
The Intricacies of Peripheral Neuropathy and Its Management
Central to the evening’s scientific session was the lecture of Dr Elaine Cunanan, the current president of the Philippine College of Endocrinology, Diabetes and Metabolism. In her lecture, she touched on the various facets of PN, including its incidence, its pathophysiology, strategies for its early detection and the holistic approach to its management.
She highlighted a particular demographic commonly affected by PN: elderly patients. Dr Cunanan presented data showing that elderly patients are at markedly higher risk of developing PN.6,7 However, she emphasized that although nerve changes may occur with age, aging in itself does not cause nerve damage.8 The predilection may be accounted for by increase diabetes risk with age9 and increased risk of vitamin B deficiency in the elderly.6,10,11
Dr Cunanan also noted polypharmacy — common in this age group commonly with multiple comorbidities — as a factor worsening vitamin B deficiency, and highlighted metformin's role in impairing B12 absorption, correlating with its dose and duration of use.12-14
She also noted that simple in-clinic assessments can aid early detection and timely intervention. Finally, Dr Cunanan discussed a new screening tool for peripheral neuropathy, "A simple sCreening Tool" (ACT), available as both a physical copy and a mobile app, which uses a series of questions and a brief physical exam to screen patients while they wait.
These simple bedside observations, combined with a thorough history, can help identify PN earlier and before functional decline sets in. The key takeaway: early diagnosis and intervention can significantly improve quality of life.15 Waiting for a patient to complain is, too often, waiting too long.
Neurotropic B Vitamins and the Evidence from the NENOIN Study
The event featured a focused discussion on the role of neurotropic B vitamins – B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) – in nerve health. Each vitamin plays a distinct role: B1 supports nerve energy metabolism, B6 maintains myelin sheath integrity and promotes biosynthesis of neurotransmitters, and B12 promotes nerve regeneration and remyelination.16 Emerging evidence shows that the combination of all three exerts synergistic effects superior to any single B vitamin administered alone.16,17
Essential insights come from 2023 secondary analysis of the NENOIN Study, a prospective, multi-center observational study of 411 patients with mild to moderate PN prescribed a fixed dose combination of B1, B6, and B12 (Neurobion® Forte) once daily for 90 days. The results demonstrated not only symptom relief, but measurable improvements in ankle and knee reflexes, sensory perception, and muscle strength – objective evidence that neurotropic B vitamins can restore nerve function, not merely mask pain.18
In her discussion, Dr Cunanan noted that these beneficial effects of neurotropic vitamin B were consistent despite the cause of neuropathy. However, she also emphasized that not all vitamin B complexes are the same, highlighting the benefits of Neurobion’s DuPro technology, which prevents the degradation of vitamin B12 as it comes into contact with gastric acid, leading to more vitamin B12 being absorbed in the small intestines.
Caring for the Hands That Care: The Campaign
Aside from the scientific discussions, at the heart of the event is a campaign that speaks not just to clinicians, but to the Filipino soul. "Caring for the Hands That Care" draws on a deeply familiar image – the hands of a parent, a lola, a lolo – hands that once cooked, worked, and sacrificed for the family. These are hands that deserve to be cared for in return, not dismissed. The campaign anchors its message on a simple but powerful question: "Is It Just Aging… or Something More?" challenging both patients and physicians to pause before accepting numbness, tingling, or weakness as an inevitable part of growing old. Through increased awareness and earlier clinical recognition, the campaign aims to bridge the gap between silent suffering and timely intervention. For the Filipino elderly, who often minimize their own discomfort out of a sense of not wanting to be a burden, this message is both timely and necessary. Caring for them starts with listening and knowing what to look for.
A Call to Action for Primary Care
The evening closed with a clear message to the physicians in the room: as the primary point of contact for elderly patients, GPs and internists are uniquely positioned to close the gap between unrecognized PN and meaningful intervention. Attendees were encouraged to recognize early symptoms rather than attribute them to aging, educate patients that these experiences are not inevitable, and initiate earlier assessment and treatment.
The campaign message – “Care for the Hands That Once Cared for Us” – resonated throughout the event. With nearly 1 in 5 elderly Filipinos potentially affected, every clinical encounter is an opportunity to act. The next time an elderly patient mentions tusok-tusok in their feet or weakness in their hands, pause, ask, and assess. What they are feeling may be far more than the passage of time.
Peripheral neuropathy (PN) refers to damage to the peripheral nerves, the network that carries signals between the central nervous system and the body, including the hands, feet, and internal organs. In elderly populations, its burden is far greater than commonly recognized.
Research estimates that nearly 1 in 5 elderly adults (18.9%) may be living with PN, particularly those over 60 years of age.1 Yet many silently endure their symptoms – numbness, tingling, weakness, and discomfort – attributing them to aging rather than to an underlying condition that warrants specific care.2
The consequences of inaction are significant. PN is an independent risk factor for falls in older adults, with downstream effects on mobility, independence, and survival.2-4 One cohort study found that elderly patients with detectable PN had a mean survival time approximately three years shorter than those without the condition.5 These figures underscore the urgency of moving from passive acceptance to proactive clinical recognition.
The Intricacies of Peripheral Neuropathy and Its Management
Central to the evening’s scientific session was the lecture of Dr Elaine Cunanan, the current president of the Philippine College of Endocrinology, Diabetes and Metabolism. In her lecture, she touched on the various facets of PN, including its incidence, its pathophysiology, strategies for its early detection and the holistic approach to its management.
She highlighted a particular demographic commonly affected by PN: elderly patients. Dr Cunanan presented data showing that elderly patients are at markedly higher risk of developing PN.6,7 However, she emphasized that although nerve changes may occur with age, aging in itself does not cause nerve damage.8 The predilection may be accounted for by increase diabetes risk with age9 and increased risk of vitamin B deficiency in the elderly.6,10,11
Dr Cunanan also noted polypharmacy — common in this age group commonly with multiple comorbidities — as a factor worsening vitamin B deficiency, and highlighted metformin's role in impairing B12 absorption, correlating with its dose and duration of use.12-14
She also noted that simple in-clinic assessments can aid early detection and timely intervention. Finally, Dr Cunanan discussed a new screening tool for peripheral neuropathy, "A simple sCreening Tool" (ACT), available as both a physical copy and a mobile app, which uses a series of questions and a brief physical exam to screen patients while they wait.
These simple bedside observations, combined with a thorough history, can help identify PN earlier and before functional decline sets in. The key takeaway: early diagnosis and intervention can significantly improve quality of life.15 Waiting for a patient to complain is, too often, waiting too long.
Neurotropic B Vitamins and the Evidence from the NENOIN Study
The event featured a focused discussion on the role of neurotropic B vitamins – B1 (thiamine), B6 (pyridoxine), and B12 (cobalamin) – in nerve health. Each vitamin plays a distinct role: B1 supports nerve energy metabolism, B6 maintains myelin sheath integrity and promotes biosynthesis of neurotransmitters, and B12 promotes nerve regeneration and remyelination.16 Emerging evidence shows that the combination of all three exerts synergistic effects superior to any single B vitamin administered alone.16,17
Essential insights come from 2023 secondary analysis of the NENOIN Study, a prospective, multi-center observational study of 411 patients with mild to moderate PN prescribed a fixed dose combination of B1, B6, and B12 (Neurobion® Forte) once daily for 90 days. The results demonstrated not only symptom relief, but measurable improvements in ankle and knee reflexes, sensory perception, and muscle strength – objective evidence that neurotropic B vitamins can restore nerve function, not merely mask pain.18
In her discussion, Dr Cunanan noted that these beneficial effects of neurotropic vitamin B were consistent despite the cause of neuropathy. However, she also emphasized that not all vitamin B complexes are the same, highlighting the benefits of Neurobion’s DuPro technology, which prevents the degradation of vitamin B12 as it comes into contact with gastric acid, leading to more vitamin B12 being absorbed in the small intestines.
Caring for the Hands That Care: The Campaign
Aside from the scientific discussions, at the heart of the event is a campaign that speaks not just to clinicians, but to the Filipino soul. "Caring for the Hands That Care" draws on a deeply familiar image – the hands of a parent, a lola, a lolo – hands that once cooked, worked, and sacrificed for the family. These are hands that deserve to be cared for in return, not dismissed. The campaign anchors its message on a simple but powerful question: "Is It Just Aging… or Something More?" challenging both patients and physicians to pause before accepting numbness, tingling, or weakness as an inevitable part of growing old. Through increased awareness and earlier clinical recognition, the campaign aims to bridge the gap between silent suffering and timely intervention. For the Filipino elderly, who often minimize their own discomfort out of a sense of not wanting to be a burden, this message is both timely and necessary. Caring for them starts with listening and knowing what to look for.
A Call to Action for Primary Care
The evening closed with a clear message to the physicians in the room: as the primary point of contact for elderly patients, GPs and internists are uniquely positioned to close the gap between unrecognized PN and meaningful intervention. Attendees were encouraged to recognize early symptoms rather than attribute them to aging, educate patients that these experiences are not inevitable, and initiate earlier assessment and treatment.
The campaign message – “Care for the Hands That Once Cared for Us” – resonated throughout the event. With nearly 1 in 5 elderly Filipinos potentially affected, every clinical encounter is an opportunity to act. The next time an elderly patient mentions tusok-tusok in their feet or weakness in their hands, pause, ask, and assess. What they are feeling may be far more than the passage of time.