The natural history of acute painful neuropathy in diabetes mellitus.

Abstract

SUMMARY Observations have been made on nine cases of painful diabetic neuropathy of acute onset. All cases were male and all were associated with and preceded by precipitous and severe weight loss. The When diabetic neuropathy was first adequately defined during the latter part of the last century, it was recognised that it could be manifested either by patchy and predominantly motor involvement or as a more diffuse and mainly sensory disorder.' The latter was subdivided into a painful or "hyperalgesic" form and an ataxic or "pseudotabetic" variety,' 2 foreshadowing the separation into small and large fibre types advocated in recent years by Brown et al.3 The features of the pain in the hyperalgesic form were documented by Pavy4 who noted that it was of burning and unremitting quality. He emphasised the characteristic exaggeration at night. It was also commented that affected individuals often complained of a sensation in the feet when walking that was likened to treading barefoot on pebbles. Focal and multifocal neuropathies such as isolated lesions of cranial or limb nerves, or diabetic amyotrophy, may also be painful.

Blood flow patterns in painful diabetic neuropathy

“…Thus, while those with severe sensory neuropathy failed to respond to sympathetic stimulation, the group with predominantly painful neuropathy did so with considerable reduction of blood flow. This response could be explained by recruitment of previously silent sympathetic units, and it is indeed considered that the electrophysiological de-fects in painful neuropathy might be less severe than in other neuropathic patients [13].…”

“…A score was then calculated for six areas; including the toes, proximal and distal half of the foot, distal, middle and proximal third of the lower leg. Thus, absent touch, pin Electrophysiological studies were not performed, and indeed correlate poorly with the clinical neuropathy, especially in cases of painful neuropathy [13].…”

“…The second group consisted of five Type 1 and three Type 2 diabetic patients with profoundly painful distal symmetrical neuropathy, sometimes described as neuropathic cachexia [12] and recently described by ourselves [13]. None had been recently started on insulin.…”

Acute Painful Neuropathy in a Girl with Type 1 Diabetes: Long Term Follow-Up

“…The findings of demyelination and axonal degeneration on nerve biopsy are often non-specific [1,4,5]. Proposed mechanisms include epineurial arterio-venous shunting causing endoneurial ischemia, apoptosis due to sudden glucose deprivation, microvascular neuronal damage due to recurrent hypoglycaemia, insulin-induced reduction in endoneurial oxygen tension due to opening of arteriovenous shunts, ectopic firing of regenerating axon sprouts, ectopic pain from regenerating nerve fibers, activation of microglia with subsequent cytokine production and immunologic reaction to insulin [1,5].…”

“…Symptomatic relief often requires sedatives and opiates analgesics either alone or in combination with various antiepileptic drugs [1][2][3][4][5]. Percutaneous electrical stimulation to the area of the pain may be beneficial in some cases [4].…”