What do general neurologists need to know about neuropathic pain?

Objective To evaluate neuropathic pain and peripheral vascular disease in diabetics and compare this with the length of time since diagnosis in type 1, and type 2 diabetes. Methods A cross-sectional study with 225 diabetics chosen from their responses on the DN4 questionnaire, who were then evaluated with the ankle-brachial index (ABI), separating type 1 diabetes from type 2 diabetes. Results A higher incidence of neuropathic pain in those over 60 years of age showed an ABI > 1.3. Neuropathic pain was related to an abnormal ABI in 144 patients (64.2%). A statistically significant value was obtained in type 2 diabetes patients with more than 10 years from disease onset, 69 with altered ABI and 25 with normal ABI. There was an altered ABI (< 0.9) observed in 33% of type 1 diabetes patients and in 67% of type 2 diabetes patients. Conclusion The ABI test in type 1 diabetes and type 2 diabetes patients is important even in those who are asymptomatic. A diagnosis of more than 10 years prior, regardless of the presence of neuropathic pain or ischemic signs, altered the ABI.

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confidence: 99%

Ankle-brachial index and diabetic neuropathy: study of 225 patients

Chevtchouk

Silva²,

Nascimento

2017

“…Actually QST measure sensory deficit that could be or not related to pain complaints. In a patient with chronic pain, lower thermal thresholds point to hyperalgesia, whereas elevated warm and heat pain thresholds point to a small fiber dysfunction which sometimes leads to neuropathic pain 6,8,11,18 . The thresholds for warm and heat pain stimuli obtained in this study are in agreement with previously published reports 4,15,19,20 .…”

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confidence: 99%

“…While the sensory stimulus is controlled by the examiner during QST, the response represents the subjective perception of thermoalgesic stimulus. If abnormal, the QST result may signalize dysfunction anywhere along the sensory pathway between thermal receptors, small fibers, spinothalamic tract and other cerebral areas i.e, pain matrix 8 . But how is perception measured?…”

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confidence: 99%

“…However, in clinical routine, because cold thresholds are more variable, warm and heat pain thresholds are measured preferentially 2 . Figure 1 shows the most common QST abnormalities in different clinical conditions 8 . In the last few years QST has been one of the main methods used in human experimental pain models and in the early diagnosis of neuropathies 6,11 .…”

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confidence: 99%

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Validation of a Brazilian quantitative sensory testing (QST) device for the diagnosis of small fiber neuropathies

Schestatsky

Stefani

Sanches³

et al. 2011

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Quantitative sensory testing (QST) is defined as the determination of thresholds for sensory perception under controlled stimulus. Our aim was to validate a new QST device for Brazilian sample. In 20 healthy adults, thermoalgesic thresholds were assessed using a QST prototype (Heat Pain Stimulator-1.1.10; Brazil). A 30 × 30 mm 2 thermode with a 1°C/s stimulus change rate were applied. Thresholds of three consecutive stimuli were averaged in two different sessions separated by at least two weeks. Additionally long thermal heat pain stimulus was performed. To evaluate the consistency of our method we also analyzed 11 patients with small fiber neuropathy. Results showed good reproducibility of thermal perception thresholds in normal individuals and plausible abnormal thresholds in patients. We conclude that our QST device is reliable when analyzing the nociceptive pathway in controls and patients.

“…Patients with NP usually complain of burning and tingling sensations over the skin that almost always correspond to a plausible body distribution. Antidepressants and antiepileptic drugs are the mainstay of therapy, but they usually relieve only 40-50% of the pain 2 . Since the diagnosis of NP has becoming clearer in the last few years with the advent of new neurophysiological and histological tools, it is believed that the diversity of pathophysiological mechanism might explain the refractoriness of NP to the conventional therapeutic approaches.…”

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confidence: 99%

Promising treatments for neuropathic pain

Schestatsky

Vidor

Winckler

et al. 2014

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In the last few years the understanding of mechanisms and, consequently, the diagnosis of neuropathic pain (NP) has becoming progressively clearer in clinical practice. However, the treatment of such condition remains challenging so far. One of the reasons for such difficulty is the diversity of mechanisms involved in NP generation and its persistency. In the present review we discuss several treatment modalities for NP that are scantily applied in daily clinical practice. For that, we collected positive clinical evidence of unusual and SECS (Safe, Easy, Cheap, and Sensible) approaches for NP. The aim of this review is not to establish the "state of the art" or rigid guidelines for NP treatment. In a different way, we only want bring new possibilities of treatment to the readers and also to motivate investigators to confirm those positive preliminary but promising results for NP reliev.Keywords: neuropathic pain, treatment, unconventional, alternative, evidence-based medicine. RESUMONos últimos anos, a compreensão dos mecanismos e consequentemente do diagnóstico da dor neuropática (DN) têm se tornado cada vez mais claros na prática clínica. Entretanto, o tratamento desta condição continua sendo um desafio. Uma das razões para tal dificuldade é diversidade de mecanismos envolvidos na geração e perpetuação da DN. Na presente revisão, os autores discutem várias modalidades de tratamento para DN pouco utilizadas na prática clínica diária. Para isso, selecionamos evidências clínicas positivas de abordagens para DN consideradas não-convencionais e do tipo "SFBR" (Seguro, Fácil, Barato e Racional). O objetivo desta revisão não é estabelecer o "estado da arte" ou diretrizes rígidas para o tratamento da DN. Diferente disso, pretendemos apenas trazer aos leitores novas possibilidades de tratamento assim como motivar pesquisadores a confirmar estes resultados preliminares, mas promissores para o alívio da DN.Palavras-chave: dor neuropática, tratamento, alternativo, medicina baseada em evidência.Neuropathic pain is defined as pain caused by lesion or dysfunction of the somatosensory system 1 and is most commonly consequence from several clinical conditions, such as diabetes, chemotherapy, herpes zoster infection, chronic alcohol abuse and other idiopathic conditions, such as idiopathic small fiber neuropathy and trigeminal pain. Patients with NP usually complain of burning and tingling sensations over the skin that almost always correspond to a plausible body distribution. Antidepressants and antiepileptic drugs are the mainstay of therapy, but they usually relieve only 40-50% of the pain 2 . Since the diagnosis of NP has becoming clearer in the last few years with the advent of new neurophysiological and histological tools, it is believed that the diversity of pathophysiological mechanism might explain the refractoriness of NP to the conventional therapeutic approaches. Therefore, several lines of investigation have been developed in parallel with the sophistication of usual drugs used in NP patients. Some of these...