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Diagnosis of Painful Diabetic Neuropathy

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Painful Diabetic Polyneuropathy

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Abstract

Painful diabetic neuropathy (PDN) is found in about 16 % of diabetes patients and is not optimally managed in that 40 % of individuals with PDN are untreated [1]. Such gaps in care produce patient dissatisfaction and negatively impact quality of life [2]. Since efficacious, evidence-based treatments are available for PDN [3], it becomes important to understand why treatment is not offered to patients. In part, this lack of treatment may arise from failure to make the diagnosis of PDN. This chapter aims to present a discussion concerning the diagnosis of PDN that may allow better treatment of patients.

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References

  1. Daousi C, MacFarlane IA, Woodward A, Nurmikko TJ, Bundred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a controlled comparison of people with and without diabetes. Diabet Med. 2004;21(9):976–82.

    Article  PubMed  CAS  Google Scholar 

  2. Gore M, Brandenburg N, Hoffman D, Tai K. Burden of illness in painful diabetic peripheral neuropathy: the patients’ perspectives. J Pain. 2006;7(12):892–900.

    Article  PubMed  Google Scholar 

  3. Bril V, England J, Franklin GM, Backonja M, Cohen J, Del Toro D, et al. Evidence-based guideline: treatment of painful diabetic neuropathy: report of the American Academy of Neurology, the American Association of Neuromuscular and Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2011;76(20):1758–65.

    Article  PubMed  CAS  Google Scholar 

  4. Vileikyte L, Gonzalez JS, Garrow AP, Stickings D, Waterman C, Ulbrecht JS, et al. Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia. 2009;52(7):1265–73.

    Article  PubMed  CAS  Google Scholar 

  5. Bouhassira D, Attal N. Diagnosis and assessment of neuropathic pain: the saga of clinical tools. Pain. 2011;152(3 Suppl):S74–83.

    Article  PubMed  Google Scholar 

  6. Attal N, Bouhassira D, Baron R, Dostrovsky J, Dworkin RH, Finnerup N, et al. Assessing symptom profiles in neuropathic pain clinical trials: can it improve outcome? Eur J Pain. 2011; 15(5):441–3.

    Article  PubMed  Google Scholar 

  7. Hartemann A, Attal N, Bouhassira D, Dumont I, Gin H, Jeanne S, et al. Painful diabetic neuropathy: diagnosis and management. Diabete Metab. 2011;37(5):377–88.

    Article  PubMed  CAS  Google Scholar 

  8. Zelman DC, Gore M, Dukes E, Tai K-S, Brandenburg N. Validation of a modified version of the brief pain inventory for painful diabetic peripheral neuropathy. J Pain Symptom Manage. 2005;29(4):401–10.

    Article  PubMed  Google Scholar 

  9. Krause SJ, Backonja M-M. Development of a neuropathic pain questionnaire. Clin J Pain. 2003;19(5):306–14.

    Article  PubMed  Google Scholar 

  10. Backonja M-M, Krause SJ. Neuropathic pain questionnaire—short form. Clin J Pain. 2003;19(5):315–6.

    Article  PubMed  Google Scholar 

  11. Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, et al. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108(3):248–57.

    Article  PubMed  Google Scholar 

  12. Galer BS, Jensen MP. Development and preliminary validation of a pain measure specific to neuropathic pain: the Neuropathic Pain Scale. Neurology. 1997;48(2):332–8.

    Article  PubMed  CAS  Google Scholar 

  13. Bouhassira D, Attal N. All in one: is it possible to assess all dimensions of any pain with a simple questionnaire? Pain. 2009;144(1–2):7–8.

    Article  PubMed  Google Scholar 

  14. Perkins BA, Olaleye D, Zinman B, Bril V. Simple screening tests for peripheral neuropathy in the diabetes clinic. Diabetes Care. 2001;24(2):250–6.

    Article  PubMed  CAS  Google Scholar 

  15. Bril V, Tomioka S, Buchanan RA, Perkins BA, mTCNS Study Group. Reliability and validity of the modified Toronto Clinical Neuropathy Score in diabetic sensorimotor polyneuropathy. Diabet Med. 2009;26(3):240–6.

    Article  PubMed  CAS  Google Scholar 

  16. Zinman LH, Bril V, Perkins BA. Cooling detection thresholds in the assessment of diabetic sensory polyneuropathy: comparison of CASE IV and Medoc instruments. Diabetes Care. 2004;27(7):1674–9.

    Article  PubMed  Google Scholar 

  17. Bril V, Kojic J, Clark K. Comparison of a neurothesiometer and vibratron in measuring vibration perception thresholds and relationship to nerve conduction studies. Diabetes Care. 1997;20(9):1360–2.

    Article  PubMed  CAS  Google Scholar 

  18. Dyck PJ, Bushek W, Spring EM, Karnes JL, Litchy WJ, O’Brien PC, et al. Vibratory and ­cooling detection thresholds compared with other tests in diagnosing and staging diabetic ­neuropathy. Diabetes Care. 1987;10(4):432–40.

    Article  PubMed  CAS  Google Scholar 

  19. Gerr F, Letz R, Hershman D, Farraye J, Simpson D. Comparison of vibrotactile thresholds with physical examination and electrophysiological assessment. Muscle Nerve. 1991;14(11): 1059–66.

    Article  PubMed  CAS  Google Scholar 

  20. Gelber DA, Pfeifer MA, Broadstone VL, Munster EW, Peterson M, Arezzo JC, et al. Components of variance for vibratory and thermal threshold testing in normal and diabetic subjects. J Diabetes Complications. 1995;9(3):170–6.

    Article  PubMed  CAS  Google Scholar 

  21. Krishnan STM, Rayman G. The LDIflare: a novel test of C-fiber function demonstrates early neuropathy in type 2 diabetes. Diabetes Care. 2004;27(12):2930–5.

    Article  PubMed  Google Scholar 

  22. Krishnan STM, Quattrini C, Jeziorska M, Malik RA, Rayman G. Abnormal LDIflare but normal quantitative sensory testing and dermal nerve fiber density in patients with painful diabetic neuropathy. Diabetes Care. 2009;32(3):451–5.

    Article  PubMed  Google Scholar 

  23. Green AQ, Krishnan STM, Rayman G. C-fiber function assessed by the laser doppler imager flare technique and acetylcholine iontophoresis. Muscle Nerve. 2009;40(6):985–91.

    Article  PubMed  Google Scholar 

  24. Lauria G, Cornblath DR, Johansson O, McArthur JC, Mellgren SI, Nolano M, et al. EFNS guidelines on the use of skin biopsy in the diagnosis of peripheral neuropathy. Eur J Neurol. 2005;12(10):747–58.

    Article  PubMed  CAS  Google Scholar 

  25. England JD, Kinsella LJ, Cohen JA, Asbury AK, Szigeti K, Lupski JR, et al. Practice parameter: evaluation of distal symmetric polyneuropathy: role of autonomic testing, nerve biopsy, and skin biopsy (an evidence-based review). Report of the American Academy of Neurology, American Association of Neuromuscular and Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation. Neurology. 2009;72(2):177–84.

    Article  PubMed  CAS  Google Scholar 

  26. Kennedy WR, Wendelschafer-Crabb G, Johnson T. Quantification of epidermal nerves in ­diabetic neuropathy. Neurology. 1996;47(4):1042–8.

    Article  PubMed  CAS  Google Scholar 

  27. Lauria G, Holland N, Hauer P, Cornblath DR, Griffin JW, McArthur JC. Epidermal innervation: changes with aging, topographic location, and in sensory neuropathy. J Neurol Sci. 1999; 164(2):172–8.

    Article  PubMed  CAS  Google Scholar 

  28. Umapathi T, Tan WL, Loke SC, Soon PC, Tavintharan S, Tavintharan S, Chan YH. Intraepidermal nerve fiber density as a marker of early diabetic neuropathy. Muscle Nerve. 2007;35(5):591–8.

    Article  PubMed  CAS  Google Scholar 

  29. Tan IL, Polydefkis MJ, Ebenezer GJ, Hauer P, McArthur JC. Peripheral nerve toxic effects of nitrofurantoin. Arch Neurol. 2012;69(2):265–8.

    Article  PubMed  Google Scholar 

  30. Malik RA, Kallinikos P, Abbott CA, van Schie CH, Morgan P, Efron N, et al. Corneal confocal microscopy: a non-invasive surrogate of nerve fibre damage and repair in diabetic patients. Diabetologia. 2003;46(5):683–8.

    PubMed  CAS  Google Scholar 

  31. Hertz P, Bril V, Orszag A, Ahmed A, Ng E, Nwe P, et al. Reproducibility of in vivo corneal confocal microscopy as a novel screening test for early diabetic sensorimotor polyneuropathy. Diabet Med. 2011;28(10):1253–60.

    Article  PubMed  CAS  Google Scholar 

  32. Attal N, Cruccu G, Baron R, Haanpaa M, Hansson P, Jensen TS, et al. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9): 1113–88.

    Article  PubMed  CAS  Google Scholar 

  33. Dworkin RH, O’Connor AB, Audette J, Baron R, Gourlay GK, Haanpää ML, et al. Recommendations for the pharmacological management of neuropathic pain: an overview and literature update. Mayo Clin Proc. 2010;85(3 Suppl):S3–14.

    Article  PubMed  CAS  Google Scholar 

  34. Kieburtz K, Simpson D, Yiannoutsos C, Max MB, Hall CD, Ellis RJ, et al. A randomized trial of amitriptyline and mexiletine for painful neuropathy in HIV infection. AIDS Clinical Trial Group 242 Protocol Team. Neurology. 1998;51(6):1682–8.

    Article  PubMed  CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Division of Neurology, Department of Medicine, University Health Network, 5EC-309, TGH, 200 Elizabeth Street, Toronto, ON, Canada, M5G 2C4

    Vera Bril B.Sc., M.D., F.R.C.P.C.

  2. Division of Metabolism and Endocrinology, Department of Medicine, University Health Network, Toronto, ON, Canada, M5G 2C4

    Bruce A. Perkins M.D., M.P.H.

Authors
  1. Vera Bril B.Sc., M.D., F.R.C.P.C.
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  2. Bruce A. Perkins M.D., M.P.H.
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Corresponding author

Correspondence to Vera Bril B.Sc., M.D., F.R.C.P.C. .

Editor information

Editors and Affiliations

  1. , Department of Anesthesiology, University of California San Diego, Campus Point Dr 9300, La Jolla, 92037, California, USA

    Erin Lawson

  2. , Department of Neurology, University of Wisconsin, Highland Avenue 1685, Madison, 53705-2281, Wisconsin, USA

    Miroslav "Misha" Backonja

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Bril, V., Perkins, B.A. (2013). Diagnosis of Painful Diabetic Neuropathy. In: Lawson, E., Backonja, M. (eds) Painful Diabetic Polyneuropathy. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6299-6_3

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  • DOI: https://doi.org/10.1007/978-1-4614-6299-6_3

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6298-9

  • Online ISBN: 978-1-4614-6299-6

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