Painful and Painless Diabetic Neuropathies: What Is the Difference?

Abstract

Purpose of Review The prevalence of diabetes mellitus and its chronic complications are increasing to epidemic proportions. This will unfortunately result in massive increases in diabetic distal symmetrical polyneuropathy (DPN) and its troublesome sequelae, including disabling neuropathic pain (painful-DPN), which affects around 25% of patients with diabetes. Why these patients develop neuropathic pain, while others with a similar degree of neuropathy do not, is not clearly understood. This review will look at recent advances that may shed some light on the differences between painful and painless-DPN. Recent Findings Gender, clinical pain phenotyping, serum biomarkers, brain imaging, genetics, and skin biopsy findings have been reported to differentiate painful- from painless-DPN. Summary Painful-DPN seems to be associated with female gender and small fiber dysfunction. Moreover, recent brain imaging studies have found neuropathic pain signatures within the central nervous system; however, whether this is the cause or effect of the pain is yet to be determined. Further research is urgently required to develop our understanding of the pathogenesis of pain in DPN in order to develop new and effective mechanistic treatments for painful-DPN.

New Perspective in Diabetic Neuropathy: From the Periphery to the Brain, a Call for Early Detection, and Precision Medicine

“…Recent advances suggest that the cumulative effect of these injurious events may lead to neuronal death via reactive oxygen species generation and mitochondrial dysfunction. Furthermore, mechanistic and pathological findings do not discriminate between painful-and painless-DPN (12).…”

“…The mainstay of modern management is to control risk factors for DPN, and prevent and manage its complications (10). Similarly, although a number of differences have been discovered between painless-and painful-DPN, the specific mechanisms causing the condition are unknown (11,12). Disease modifying treatments are not widely used for painful-DPN and the treatment remains largely symptomatic (11,12).…”

“…Similarly, although a number of differences have been discovered between painless-and painful-DPN, the specific mechanisms causing the condition are unknown (11,12). Disease modifying treatments are not widely used for painful-DPN and the treatment remains largely symptomatic (11,12). Unfortunately, the available treatments for neuropathic pain are often ineffective and poorly tolerated (13).…”

Застосування Нуклео Ц.М.Ф. Форте В Комплексному Лікуванні Діабетичної Полінейропатії

“…У практиці лікаря-ендокринолога часто зустрічаються ускладнення з боку нервової системи. Серед неврологічних ускладнень ендокринних захворювань провідне місце посідають полінейропатії [1][2][3].…”

“…Діабетична полінейропатія (ДПН) -найбільш часте й небезпечне ускладнення ЦД. Поширеність ДПН становить 20-54 % і залежить від чутливості й специфічності методів, які використовують у діагностиці [2][3][4].…”