A new look at painful diabetic neuropathy

The prevalence of diabetes mellitus and its chronic complications continue to increase alarmingly. Consequently, the massive expenditure on diabetic distal symmetrical polyneuropathy (DSPN) and its sequelae, will also likely rise. Up to 50% of patients with diabetes develop DSPN, and about 20% devel...

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Bibliographic Details
Published inDiabetes research and clinical practice Vol. 144; pp. 177 - 191
Main Authors Sloan, Gordon, Shillo, Pallai, Selvarajah, Dinesh, Wu, Jing, Wilkinson, Iain D., Tracey, Irene, Anand, Praveen, Tesfaye, Solomon
Format Journal Article
LanguageEnglish
Published Ireland Elsevier B.V 01.10.2018
Subjects
Diabetes
Diabetic Neuropathies - complications
Diabetic Neuropathies - physiopathology
Humans
IENFD
MRI
Neuropathic pain
Pain - diagnosis
Pain - etiology
Peripheral neuropathy
Pre-diabetic neuropathy
Skin biopsy
Small fibre neuropathy
Voltage gated sodium channels
Small fibre neuropathy
IENFD
MRI
Skin biopsy
Pre-diabetic neuropathy
Diabetes
Voltage gated sodium channels
Peripheral neuropathy
Neuropathic pain
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Summary:The prevalence of diabetes mellitus and its chronic complications continue to increase alarmingly. Consequently, the massive expenditure on diabetic distal symmetrical polyneuropathy (DSPN) and its sequelae, will also likely rise. Up to 50% of patients with diabetes develop DSPN, and about 20% develop neuropathic pain (painful-DSPN). Painful-DSPN can cast a huge burden on sufferers’ lives with increased rates of unemployment, mental health disorders and physical co-morbidities. Unfortunately, due to limited understanding of the mechanisms leading to painful-DSPN, current treatments remain inadequate. Recent studies examining the pathophysiology of painful-DSPN have identified maladaptive alterations at the level of both the peripheral and central nervous systems. Additionally, genetic studies have suggested that patients with variants of voltage gated sodium channels may be more at risk of developing neuropathic pain in the presence of a disease trigger such as diabetes. We review the recent advances in genetics, skin biopsy immunohistochemistry and neuro-imaging, which have the potential to further our understanding of the condition, and identify targets for new mechanism based therapies.
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ISSN:0168-8227
1872-8227
DOI:10.1016/j.diabres.2018.08.020