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Diabetes mellitus is one of the most common chronic medical conditions
to 60% may develop diabetic polyneuropathy
- the incidence is linked to
the duration of diabetes
- among diabetic neuropathic patients within the
UK, between 43% and 53% experienced painful symptoms to the lower limb (1)
- pathogenesis of painful symptoms remains unclear
studies have not demonstrated structural or functional differences in nerve fibres
between painful and painless diabetic neuropathy
- one study did demonstrate
higher plasma norepinephrine levels in patients with painful compared with painless
- the DCCT trial showed a reduced incidence of diabetic
neuropathy in the intensive glycaemic control treatment group (3)
patients with painful neuropathy seem to have increased blood glucose flux and
perhaps poorer glycaemic control compared with those with painless neuropathy
- paradoxically an insulin neuritis has been noted to occur
following rapid improvement in glycaemic control (5)
- some have related
this complication to endoneurial ischaemia, perhaps due to insulin-induced neural
neovascularization and arterio-venous shunting (4)
- symptoms of painful diabetic neuropathy include burning pains,
pins and needles, shooting pains down the legs, increased touch sensation (hyperaesthesia),
and even numbness
- measurement of clinical
pain is difficult because it can be influenced by the individual personality,
past experiences and other psychological variables. Therefore pain assessment
has to rely on subjective evaluation
M et al. The pathogenesis and management of painful diabetic neuropathy: a review.
Diabetic Medicine 2003;20 (2): 88-98
S. J. et al. Painful diabetic neuropathy. Diabetic Medicine 1999;16 (8): 632-644.
Diabetes Control and Complications Trial Research Group. The effect of intensive
treatment of diabetes on the development and progression of long-term complications
in insulin-dependent diabetes mellitus. New Engl. J. Med. 1993; 32(14): 977-86.
M, Zollman PJ, Smithson IL, Lagerlund TD, Low PA. Hypoxic effect of exogenous
insulin on normal and diabetic peripheral nerve. Am J Physiol 1994; 226: E980–985
S et al.The relationship between blood glucose excursions and painful diabetic
peripheral neuropathy: a pilot study. Diabetic Medicine 2002;19 (10): 870-873.
Last reviewed 01/2018