Painful Diabetic Neuropathy

Brown, Mark J.; Martin, John R.; Asbury, Arthur K.

doi:10.1001/archneur.1976.00500030020004

Cited by 236 publications

(86 citation statements)

References 31 publications

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“…Degenerative changes and fiber loss in unmyelinated nerve fibers and small myelinated nerve fibers occur earlier and more severely in diabetic neuropathy. 16 Impaired temperature, pain and touch sensations in extremities are prominent in relation with neurologic symptoms. On the other hand, large myeliniated sensory fibers are responsible for vibration sensation, and are also affected in the pathogenesis of diabetes.…”

Section: Discussionmentioning

confidence: 99%

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

et al. 2003

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To evaluate genital and extragenital somatic sensory system in diabetic women using biothesiometry and investigate the relation with sexual dysfunction. A total of 30 diabetic women and 20 normal sexually active women as a control group were evaluated with a detailed medical and sexual history including Index of Female Sexual Function (IFSF) questionnaire. Somatic sensory system of all women enrolled to the study was assessed by biothesiometry and threshold sensory values of nine genital sites and 14 extragenital sites were analyzed. The IFSF score in diabetic women was 23.6 while it was 38.3 in the control group (o0.0005). For each genital as well as extragenital sites, the mean biothesiometric values were significantly higher in diabetics. The sensation of introitus vagina, labium minora and clitoris were found to be the most deteriorated genital sites in diabetic women. The difference between diabetic women with or without female sexual dysfunction (FSD) was not significant for biothesiometric values. Our data indicate that, somatic sensory system is affected by diabetes however sexual dysfunction does not always manifest.

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Section: Discussionmentioning

confidence: 99%

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

et al. 2003

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“…There was no morphologic evidence of sprouting of unmyelinated axons. Regenerating sprouts are expected to have unusually small calibers (Brown et al, 1976), and at the early stages may be clustered in polyaxonal pockets. We saw neither of these features in the rhGDNF-treated animals.…”

Section: Myelination Of Small Axonsmentioning

confidence: 99%

Glial Cell Line-Derived Neurotrophic Factor Alters Axon Schwann Cell Units and Promotes Myelination in Unmyelinated Nerve Fibers

et al. 2003

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Glial cell line-derived neurotrophic factor (GDNF) plays an important role in the development and maintenance of a subset of dorsal root ganglion sensory neurons. We administered high-dose exogenous recombinant human GDNF (rhGDNF) daily to adult rats to examine its effect on unmyelinated axon-Schwann cell units in intact peripheral nerves. In rhGDNF-treated animals, there was a dramatic proliferation in the Schwann cells of unmyelinated fibers, which resulted in the segregation of many unmyelinated axons into a 1:1 relationship with Schwann cells and myelination of normally unmyelinated small axons. This study demonstrates that the administration of high doses of a growth factor to adult rats can change the phenotype of nerve fibers from unmyelinated to myelinated.

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“…SSFN is well known as a common disorder in both pre-diabetes, that is, impaired glucose tolerance (IGT) 5 and in fully developed diabetes. 6,7 Sumner et al 7 claim that it is the small nerve fibers that are notably impaired in IGT, whereas both small and large fibers are affected in diabetes. Indeed, small nerve fibers may offer the earliest detectable sign of impending neuropathy in persons with glucose dysmetabolism and/or with insulin resistance.…”

Section: Introductionmentioning

confidence: 99%

Prevalence of somatic small fiber neuropathy in obesity

et al. 2006

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Background: Somatic cutaneous small sensory fiber neuropathy (SSFN) can be an early manifestation of impaired glucose tolerance and diabetes mellitus and/or insulin resistance among obese subjects and is often associated with pain, wound occurrence and impaired wound healing. It is yet unclear as to whether SSFN is prevalent among obese individuals without glucose and/or insulin dysregulation despite abundant evidence of delayed wound healing. Objective: To observe whether there is hypofunctioning of stimulated capsaicin-sensitive cutaneous nerves (small sensory fibers) in obese subjects with/without hyperglycemia and hyperinsulinemia. Design, setting and participants: Fifty-eight morbidly obese and 15 lean subjects were recruited for small fiber testing of the forearm in a cross-sectional study. Hyperglycemia was observed in 35 obese subjects. Of 25 obese subjects, hyperinsulinemia was noted in 15, 14 of which were hyperglycemic. No subjects demonstrated symptoms/signs of neuropathy over the hairy skin of the forearm. In fact, a neurological examination revealed that 37 subjects were asymptomatic in the legs and only four complained of a neuropathic pain in the foot. Virtually all subjects were exposed to a set of capsaicin-sensitive tests and measures which were identified by capsaicin desensitization procedures. These tests, conducted while in a supine position in bed at the Banner Good Samaritan Medical Center, Phoenix, examined the two principle roles of cutaneous SSFs, namely conveying pain signals to the CNS and controlling local neurogenic vasodilatation (flare; axon-reflex). Main outcome measures: Heat-induced pain was assessed by verbal reports of sensation after accommodation and heat-, capsaicin-, and transcutneous stimulation-induced blood flow was measured by laser Doppler flowmetry with probes placed at the site of stimulation and 1 cm remote from the site, the latter to evaluate flare latency and intensity of flare. Results: Significant depression of pain and flare responses were observed in the obese subjects in all but one test. Decreased pain and flare responses were noted in all subjects without hyperglycemia and hyperinsulinemia. Age negatively correlated with capsaicin-induced flare in both the obese and normal groups. Conclusion: SSFN was prevalent in the cohort of morbidly obese subjects in a skin area without neurological symptoms or signs and in subjects with/without hyperglycemia and hyperinsulinemia. SSFN may be a serious factor in observations of impaired wound healing among obese subjects, a particularly worrisome problem in an obese aging population given the propensity for small fiber impairment in aging subjects. Small fiber impairment in the younger obese population may signal an early aging phenomenon.

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Painful Diabetic Neuropathy

Cited by 236 publications

References 31 publications

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

Does sexual dysfunction correlate with deterioration of somatic sensory system in diabetic women?

Glial Cell Line-Derived Neurotrophic Factor Alters Axon Schwann Cell Units and Promotes Myelination in Unmyelinated Nerve Fibers

Prevalence of somatic small fiber neuropathy in obesity

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