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Small-fibre involvement in diabetic patients with neuropathic foot pain.
Diabet Med. 2008 Jun; 25(6):692-9.DM

Abstract

AIMS

To assess small-fibre involvement in diabetic patients with neuropathic pain.

METHODS

Peripheral nerve function was assessed in 30 patients with Type 2 diabetes mellitus (T2DM, n = 24) or impaired glucose tolerance (IGT, n = 6), and clinical symptoms of neuropathic pain in the feet, using nerve conduction studies, autonomic tests, thermal quantitative sensory testing (T-QST) and quantification of intra- and subepidermal nerve fibre densities in skin punch biopsies.

RESULTS

Clinical signs of isolated small-fibre sensory involvement were present in 13 patients [pure small-fibre neuropathy (pSFN)], seven patients had isolated positive sensory symptoms without neurological deficits (pSFN-). Ten patients had concomitant electrophysiological and/or clinical signs of large-fibre sensory involvement [mixed-fibre neuropathy (MFN)]. Twenty-seven patients (90%) had both reduced skin innervation and abnormalities of the T-QST parameters. Two other patients displayed either abnormal skin innervation or T-QST, and only one patient had normal findings on both tests. The criteria of small-fibre neuropathy (SFN) were met in all 20 patients without large-fibre involvement. Small-fibre involvement was also present in the 10 MFN patients. Both T-QST and skin biopsy parameters revealed significant differences between these clinical subgroups, with increased severity of small-fibre involvement in the MFN group. Autonomic dysfunction was found in 43% of patients and did not correlate with either clinical, T-QST or skin biopsy data.

CONCLUSIONS

Although the exact mechanism of neuropathic pain in diabetic patients is not known, pain is almost invariably accompanied by small-fibre dysfunction and pathology irrespective of autonomic or large-fibre involvement.

Authors+Show Affiliations

Department of Neurology, Faculty Hospital and Medical Faculty of the Masaryk University, Brno, Czech Republic. evlckova@email.czNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

18544107

Citation

Vlckova-Moravcova, E, et al. "Small-fibre Involvement in Diabetic Patients With Neuropathic Foot Pain." Diabetic Medicine : a Journal of the British Diabetic Association, vol. 25, no. 6, 2008, pp. 692-9.
Vlckova-Moravcova E, Bednarik J, Belobradkova J, et al. Small-fibre involvement in diabetic patients with neuropathic foot pain. Diabet Med. 2008;25(6):692-9.
Vlckova-Moravcova, E., Bednarik, J., Belobradkova, J., & Sommer, C. (2008). Small-fibre involvement in diabetic patients with neuropathic foot pain. Diabetic Medicine : a Journal of the British Diabetic Association, 25(6), 692-9. https://doi.org/10.1111/j.1464-5491.2008.02446.x
Vlckova-Moravcova E, et al. Small-fibre Involvement in Diabetic Patients With Neuropathic Foot Pain. Diabet Med. 2008;25(6):692-9. PubMed PMID: 18544107.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Small-fibre involvement in diabetic patients with neuropathic foot pain. AU - Vlckova-Moravcova,E, AU - Bednarik,J, AU - Belobradkova,J, AU - Sommer,C, PY - 2008/6/12/pubmed PY - 2008/8/2/medline PY - 2008/6/12/entrez SP - 692 EP - 9 JF - Diabetic medicine : a journal of the British Diabetic Association JO - Diabet Med VL - 25 IS - 6 N2 - AIMS: To assess small-fibre involvement in diabetic patients with neuropathic pain. METHODS: Peripheral nerve function was assessed in 30 patients with Type 2 diabetes mellitus (T2DM, n = 24) or impaired glucose tolerance (IGT, n = 6), and clinical symptoms of neuropathic pain in the feet, using nerve conduction studies, autonomic tests, thermal quantitative sensory testing (T-QST) and quantification of intra- and subepidermal nerve fibre densities in skin punch biopsies. RESULTS: Clinical signs of isolated small-fibre sensory involvement were present in 13 patients [pure small-fibre neuropathy (pSFN)], seven patients had isolated positive sensory symptoms without neurological deficits (pSFN-). Ten patients had concomitant electrophysiological and/or clinical signs of large-fibre sensory involvement [mixed-fibre neuropathy (MFN)]. Twenty-seven patients (90%) had both reduced skin innervation and abnormalities of the T-QST parameters. Two other patients displayed either abnormal skin innervation or T-QST, and only one patient had normal findings on both tests. The criteria of small-fibre neuropathy (SFN) were met in all 20 patients without large-fibre involvement. Small-fibre involvement was also present in the 10 MFN patients. Both T-QST and skin biopsy parameters revealed significant differences between these clinical subgroups, with increased severity of small-fibre involvement in the MFN group. Autonomic dysfunction was found in 43% of patients and did not correlate with either clinical, T-QST or skin biopsy data. CONCLUSIONS: Although the exact mechanism of neuropathic pain in diabetic patients is not known, pain is almost invariably accompanied by small-fibre dysfunction and pathology irrespective of autonomic or large-fibre involvement. SN - 1464-5491 UR - https://www.unboundmedicine.com/medline/citation/18544107/Small_fibre_involvement_in_diabetic_patients_with_neuropathic_foot_pain_ L2 - https://doi.org/10.1111/j.1464-5491.2008.02446.x DB - PRIME DP - Unbound Medicine ER -