Differences in Metabolites in Pain-Processing Brain Regions in Patients With Diabetes and Painful Neuropathy

Sorensen, Lea; Siddall, P.J.; Trenell, Michael I.; Yue, Dennis K.

doi:10.2337/dc07-2088

Cited by 84 publications

(64 citation statements)

References 6 publications

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“…Images are presented according to neurologic convention, with right hemisphere structures shown on the right. However, evidence is now emerging that the impact of this disorder may be more generalized than previously thought, involving the spinal cord and thalamus (8,10,35). It seems logical therefore to investigate whether other areas of the brain may also be affected by the neuropathic process.…”

Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Neuroimaging Study of Brain Structural Differences in Diabetic Peripheral Neuropathy

et al. 2014

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OBJECTIVEDiabetic peripheral neuropathy (DPN) has hitherto been considered a disease of the peripheral nervous system only, with central nervous system (CNS) involvement largely overlooked. The aim of this study was to investigate any differences in brain structure in subjects with DPN. RESEARCH DESIGN AND METHODSThirty-six subjects with type 1 diabetes (No DPN [n = 18], Painful DPN [n = 9], Painless DPN [n = 9]) underwent neurophysiological assessment to quantify the severity of DPN. All subjects, including 18 healthy volunteers (HVs), underwent volumetric brain magnetic resonance imaging at 3 Tesla. RESULTSAdjusted peripheral gray matter volume was statistically significantly lower in subjects with painless and painful DPN (mean 599.6 mL [SEM 9.8 mL] and 585.4 mL [10.0 mL], respectively) compared with those with No DPN (626.5 mL [5.7 mL]) and HVs (639.9 mL [7.2 mL]; ANCOVA, P = 0.001). The difference in adjusted peripheral gray matter volume between subjects with No DPN and HVs and those with Painful DPN and Painless DPN was not statistically significant (P = 0.16 and 0.30, respectively). Voxel-based morphometry analyses revealed greater localized volume loss in the primary somatosensory cortex, supramarginal gyrus, and cingulate cortex (corrected P < 0.05) in DPN subjects. CONCLUSIONSThis is the first study to focus on structural changes in the brain associated with DPN. Our findings suggest increased peripheral gray matter volume loss, localized to regions involved with somatosensory perception in subjects with DPN. This may have important implications for the long-term prognosis of DPN.Diabetic peripheral neuropathy (DPN) is a common, debilitating, and distressing complication that develops in up to 30-50% of patients with diabetes (1). A painless distal symmetrical sensorimotor neuropathy, which increases the risk of foot ulceration and subsequent amputation, develops in most patients. In a significant proportion of patients, a chronic painful condition also develops, which can result in considerable disability and suffering. Although various vascular and metabolic factors (2) have been implicated, a complete understanding of the pathogenesis of DPN remains elusive (3,4). DPN has hitherto been considered a disease of the peripheral

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Section: Discussionmentioning

confidence: 99%

Magnetic Resonance Neuroimaging Study of Brain Structural Differences in Diabetic Peripheral Neuropathy

et al. 2014

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“…Diabetic subjects had decreased brain Nacetyl aspartate (NAA) levels relative to the control group. Moreover, diabetic subjects suffering from pain had a greater reduction of NAA in thalamus than subjects who had diabetes but no pain [56]. These findings suggest that diabetes on its own maybe associated with metabolic changes in DLPFC [35•, 56].…”

Section: Shared Neurobiology Of Dpnp and Depression/anxietymentioning

confidence: 98%

“…In another recent study, a group of diabetic patients was compared with healthy controls using magnetic resonance spectroscopy [56]. Diabetic subjects had decreased brain Nacetyl aspartate (NAA) levels relative to the control group.…”

Section: Shared Neurobiology Of Dpnp and Depression/anxietymentioning

confidence: 98%

Painful Diabetic Neuropathy is More than Pain Alone: Examining the Role of Anxiety and Depression as Mediators and Complicators

Jain

Raison

et al. 2011

Curr Diab Rep

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A wealth of information exists regarding the plight of patients suffering with diabetic peripheral neuropathic pain (DPNP). Although physical pain is certainly a primary challenge in the management of this condition, disorders associated with emotional pain-especially depression and anxiety-also greatly complicate the clinician's efforts to attain optimal outcomes for DPNP patients. This article reviews the high rate of comorbidity between DPNP and depression/anxiety with a focus on why this pattern of comorbidity exists and what can be done about it. To accomplish this, the many physiologic similarities between neuropathic pain and depression/anxiety are reviewed as a basis for better understanding how, and why, optimal treatment strategies use behavioral and pharmacologic modalities known to improve both physical pain and symptoms of depression and anxiety. We conclude by highlighting that screening, diagnosing, and optimally treating comorbid depression/anxiety not only improves quality of life, these but also positively impacts DPNP pain.

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“…The results within the somatosensory cortex, in contrast, are suggestive of neuronal loss in subjects with DPN and may be reflecting local cerebral parenchymal atrophy. In a comparable study, Sorensen et al [75] performed H-MRS on three brain regions (thalamus, anterior cingulate cortex, and dorsolateral prefrontal cortex) in 26 subjects with diabetes and 14 healthy controls. Subjects with diabetes were subdivided into painful DPN (n=12) and painless DPN (n=14).…”

Section: Brain Mr Spectroscopy In Dpnmentioning

confidence: 98%

Central Nervous System Involvement in Diabetic Neuropathy

et al. 2011

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Diabetic neuropathy is a chronic and often disabling condition that affects a significant number of individuals with diabetes. Long considered a disease of the peripheral nervous system, there is now increasing evidence of central nervous system involvement. Recent advances in neuroimaging methods detailed in this review have led to a better understanding and refinement of how diabetic neuropathy affects the central nervous system. Recognition that diabetic neuropathy is, in part, a disease that affects the whole nervous system is resulting in a critical rethinking of this disorder, opening a new direction for further research.

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Differences in Metabolites in Pain-Processing Brain Regions in Patients With Diabetes and Painful Neuropathy

Cited by 84 publications

References 6 publications

Magnetic Resonance Neuroimaging Study of Brain Structural Differences in Diabetic Peripheral Neuropathy

Magnetic Resonance Neuroimaging Study of Brain Structural Differences in Diabetic Peripheral Neuropathy

Painful Diabetic Neuropathy is More than Pain Alone: Examining the Role of Anxiety and Depression as Mediators and Complicators

Central Nervous System Involvement in Diabetic Neuropathy

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