Skip to main content
SpringerLink
Log in

Diabetic Polyneuropathy

  • Chapter
  • First Online:
The Diabetic Foot

Part of the book series: Contemporary Diabetes ((CDI))

  • 2390 Accesses

Abstract

Diabetic neuropathy is a common complication of diabetes and a cause of considerable morbidity and increased mortality. Diabetic neuropathy is not a single entity but encompasses several neuropathic syndrome. However, by far, the commonest presentation of neuropathy in diabetes is chronic distal symmetrical polyneuropathy also commonly known as diabetic peripheral neuropathy (DPN). The Toronto Diabetic Neuropathy Consensus Panel defined DPN as “a symmetrical, length-dependent sensorimotor polyneuropathy attributable to metabolic and microvessel alterations as a result of chronic hyperglycemia exposure and cardiovascular risk covariates. An abnormality of nerve conduction (NC) tests, which is frequently subclinical, appears to be the first objective quantitative indication of the condition. The occurrences of diabetic retinopathy and nephropathy in a given patient strengthen the case that the polyneuropathy is attributable to diabetes”. This chapter covers all the neuropathic syndromes encountered in diabetes mellitus, although the main focuses are (1) DPN, which is the main initiating factor for foot ulceration and a cause of troublesome chronic painful neuropathic symptoms, and (2) autonomic neuropathy, often associated with DPN that can involve almost all the systems of the body and may have devastating consequences, such as sudden death.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 219.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Tesfaye S, Boulton AJM, Dyck PJ, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity and treatments. Diabetes Care. 2010;33:2285–93.

    PubMed  Google Scholar 

  2. Dyck PJ, Kratz KM, Karnes JL, Litchy WJ, Klein R, Pach JM, Wilson DM, O’Brien PC, Melton LJ. The prevalence by staged severity of various types of diabetic neuropathy, retinopathy, and nephropathy in a population-based cohort: the Rochester Diabetic Neuropathy Study. Neurology. 1993;43:817–24.

    PubMed  CAS  Google Scholar 

  3. Shaw JE, Zimmet PZ. The epidemiology of diabetic neuropathy. Diabetes Rev. 1999;7:245–52.

    Google Scholar 

  4. Tesfaye S, Stephens L, Stephenson J, Fuller J, Platter ME, Ionescu-Tirgoviste C, Ward JD. The prevalence of diabetic neuropathy and its relation to glycaemic control and potential risk factors: the EURODIAB IDDM Complications Study. Diabetologia. 1996;39:1377–84.

    PubMed  CAS  Google Scholar 

  5. Tesfaye S, Chaturvedi N, Eaton SEM, Witte D, Ward JD, Fuller J. Vascular risk factors and diabetic neuropathy. N Engl J Med. 2005;352:341–50.

    PubMed  CAS  Google Scholar 

  6. Andreassen CS, Jakobsen J, Ringgaard S, Ejskjaer N, Andersen H. Accelerated atrophy of lower leg and foot muscles—a follow-up study of long-term diabetic polyneuropathy using magnetic resonance imaging (MRI). Diabetologia. 2009;52(6):1182–91.

    PubMed  CAS  Google Scholar 

  7. Watkins PJ. Pain and diabetic neuropathy. Br Med J. 1984;288:168–9.

    CAS  Google Scholar 

  8. Tesfaye S, Price D. Therapeutic approaches in diabetic neuropathy and neuropathic pain. In: Boulton AJM, editor. Diabetic neuropathy. Camforth: Marius; 1997. p. 159–81.

    Google Scholar 

  9. Quattrini C, Tesfaye S. Understanding the impact of painful diabetic neuropathy. Diabetes Metab Res Rev. 2003;19 Suppl 1:S1–8.

    Google Scholar 

  10. Ewing DJ, Martyn CN, Young RJ, Clarke BF. The value of cardiovascular autonomic function tests: ten years experience in diabetes. Diabetes Care. 1985;8:491–8.

    PubMed  CAS  Google Scholar 

  11. Boulton AJ, Kirsner RS, Vileikyte Vileikyte. Clinical practice. Neuropathic diabetic foot ulcers. N Engl J Med. 2004;351(1):48–55.

    PubMed  CAS  Google Scholar 

  12. Ward JD. The diabetic leg. Diabetologia. 1982;22:141–7.

    PubMed  CAS  Google Scholar 

  13. Tesfaye S. Diabetic neuropathy: achieving best practice. Br J Vasc Dis. 2003;3:112–7.

    Google Scholar 

  14. Rajbhandari SM, Jenkins R, Davies C, Tesfaye S. Charcot neuroarthropathy in diabetes mellitus. Diabetologia. 2002;45(8):1085–96.

    PubMed  CAS  Google Scholar 

  15. Ward JD, Simms JM, Knight G, Boulton AJM, Sandler DA. Venous distension in the diabetic neuropathic foot (physical sign of arterio-venous shunting). J Roy Soc Med. 1983;76:1011–4.

    PubMed  CAS  Google Scholar 

  16. Boulton AJM, Scarpello JHB, Ward JD. Venous oxygenation in the diabetic neuropathic foot: evidence of arterial venous shunting? Diabetologia. 1982;22:6–8.

    PubMed  CAS  Google Scholar 

  17. Edmonds ME, Archer AG, Watkins PJ. Ephedrine: a new treatment for diabetic neuropathic oedema. Lancet. 1983;1:548–51.

    PubMed  CAS  Google Scholar 

  18. Young MJ, Boulton AJ, MacLeod AF, Williams DR, Sonksen PH. A multicentre study of the prevalence of diabetic peripheral neuropathy in the United Kingdom hospital clinic population. Diabetologia. 1993;36(2):150–4.

    PubMed  CAS  Google Scholar 

  19. Bril V, Perkins BA. Validation of the Toronto Clinical Scoring System for diabetic polyneuropathy. Diabetes Care. 2002;25(11):2048–52.

    PubMed  Google Scholar 

  20. Feldman EL, Stevens MJ, Thomas PK, Brown MB, Canal N, Greene DA. A practical two-step quantitative clinical and electrophysiological assessment for the diagnosis and staging of diabetic neuropathy. Diabetes Care. 1994;17(11):1281–9.

    PubMed  CAS  Google Scholar 

  21. Dyck PJ. Detection, characterization, and staging of polyneuropathy: assessed in diabetics. Muscle Nerve. 1988;11:21–32.

    PubMed  CAS  Google Scholar 

  22. Ad hoc panel on endpoints for diabetic neuropathy trials. Positive neuropathic sensory symptoms as endpoints in diabetic neuropathy trials. J Neurol Sci. 2001;189:3–6.

    Google Scholar 

  23. Dyck PJ, Overland CJ, Low PA, Litchy WJ, Davies JL, Dyck PJB, O’Brien PC, Andersen H, Albers JW, Bolton CF, England J, Klein CJ, Llewelyn G, Mauermann ML, Russell JW, Singer W, Smith G, Tesfaye S, Vella A. Signs and symptoms vs nerve conduction studies to diagnose diabetic sensorimotor polyneuropathy. Muscle Nerve. 2010;42(2):157–64.

    PubMed  Google Scholar 

  24. Archer AG, Watkins PJ, Thomas PJ, Sharma AK, Payan J. The natural history of acute painful neuropathy in diabetes mellitus. J Nurol Neorosurg Psychiatry. 1983;46:491–6.

    CAS  Google Scholar 

  25. Ellenberg M. Diabetic neuropathic cachexia. Diabetes. 1974;23:418–23.

    PubMed  CAS  Google Scholar 

  26. Devigili G, Tugnoli V, Penza P, Camozzi F, Lombardi R, Melli G, Broglio L, Granieri E, Lauria G. The diagnostic criteria for small fibre neuropathy: from symptoms to neuropathology. Brain. 2008;131(Pt 7):1912–25.

    PubMed  Google Scholar 

  27. Tesfaye S, Malik R, Harris N, Jakubowski J, Mody C, Rennie IG, Ward JD. Arteriovenous shunting and proliferating new vessels in acute painful neuropathy of rapid glycaemic control (insulin neuritis). Diabetologia. 1996;39:329–35.

    PubMed  CAS  Google Scholar 

  28. Said G, Slama G, Selva J. Progressive centripital degeneration of axons in small-fibre type diabetic polyneuropathy. A clinical and pathological study. Brain. 1983;106:791.

    PubMed  Google Scholar 

  29. Vinik AI, Park TS, Stansberry KB, Pittenger GL. Diabetic neuropathies. Diabetologia. 2000;43:957–73.

    PubMed  CAS  Google Scholar 

  30. Singleton JR, Smith AG, Bromberg MB. Increased prevalence of impaired glucose tolerance in patients with painful sensory neuropathy. Diabetes Care. 2001;24(8):1448–53.

    PubMed  CAS  Google Scholar 

  31. Veves A, Young MJ, Manes C, et al. Differences in peripheral and autonomic nerve function measurements in painful and painless neuropathy: a clinical study. Diabetes Care. 1994;17:1200–2.

    PubMed  CAS  Google Scholar 

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

    PubMed  CAS  Google Scholar 

  33. Ebenezer GJ, Hauer P, Gibbons C, McArthur JC, Polydefkis M. Assessment of epidermal nerve fibers: a new diagnostic and predictive tool for peripheral neuropathies. J Neuropathol Exp Neurol. 2007;66(12):1059–73.

    PubMed  Google Scholar 

  34. Matikainen E, Juntunen J. Diabetic neuropathy: epidemiological, pathogenetic, and clinical aspects with special emphasis on type 2 diabetes mellitus. Acta Endocrinol Suppl (Copenh). 1984;262:89–94.

    Google Scholar 

  35. Garland H. Diabetic amyotrophy. Br Med J. 1955;2:1287–90.

    PubMed  CAS  Google Scholar 

  36. Coppack SW, Watkins PJ. The natural history of femoral neuropathy. Q J Med. 1991;79:307–13.

    PubMed  CAS  Google Scholar 

  37. Casey EB, Harrison MJG. Diabetic amyotrophy: a follow-up study. Br Med J. 1972;1:656.

    PubMed  CAS  Google Scholar 

  38. Bastron JA, Thomas JE. Diabetic polyradiculoneuropathy: clinical and electromyographic findings in 105 patients. Mayo Clin Proc. 1981;56:725–32.

    PubMed  CAS  Google Scholar 

  39. Said G, Goulon-Goeau C, Lacroix C, Moulonguet A. Nerve biopsy findings in different patterns of proximal diabetic neuropathy. Ann Neurol. 1994;33:559–69.

    Google Scholar 

  40. Asbury AK, Aldredge H, Hershberg R, Fisher CM. Oculomotor palsy in diabetes mellitus: a clinicopathological study. Brain. 1970;93:555–7.

    PubMed  CAS  Google Scholar 

  41. Zorilla E, Kozak GP. Ophthalmoplegia in diabetes mellitus. Ann Intern Med. 1967;67:968–76.

    Google Scholar 

  42. Goldstein JE, Cogan DG. Diabetic ophthalmoplegia with special reference to the pupil. Arch Ophthalmol. 1960;64:592–600.

    PubMed  CAS  Google Scholar 

  43. Leslie RDG, Ellis C. Clinical course following diabetic ocular palsy. Postgrad Med J. 1978;54:791–2.

    Google Scholar 

  44. Dreyfuss PM, Hakim S, Adams RD. Diabetic ophthalmoplegia. Arch Neurol Psychiatry. 1957;77:337–49.

    Google Scholar 

  45. Ellenberg M. Diabetic truncal mononeuropathy—a new clincal syndrome. Diabetes Care. 1978;1:10–3.

    PubMed  CAS  Google Scholar 

  46. Boulton AJM, Angus E, Ayyar DR, Weiss R. Diabetic thoracic polyradiculopathy presenting as abdominal swelling. BMJ. 1984;289:798–9.

    PubMed  CAS  Google Scholar 

  47. Obrosova IG. Diabetic painful and insensate neuropathy: pathogenesis and potential treatments. Neurotherapeutics. 2009;6(4):638–47.

    PubMed  CAS  Google Scholar 

  48. Malik RA, Newrick PG, Sharma AK, Jennings A, Ah-See AK, Mayhew TM, Jakubowski J, Boulton AJM, Ward JD. Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy. Diabetologia. 1989;32:92–102.

    PubMed  CAS  Google Scholar 

  49. Bradley JL, Thomas PK, King RH, Muddle JR, Ward JD, Tesfaye S, Boulton AJM, Tsigos C, Young RJ. Myelinated nerve fibre regeneration in diabetic sensory polyneuropathy: correlation with type of diabetes. Acta Neuropathol. 1995;90:403–10.

    PubMed  CAS  Google Scholar 

  50. Cameron NE, Eaton SE, Cotter MA, Tesfaye S. Vascular factors and metabolic interactions in the pathogenesis of diabetic neuropathy. Diabetologia. 2001;44:1973–88.

    PubMed  CAS  Google Scholar 

  51. Pacher P, Obrosova IG, Mabley JG, Szabó C. Role of nitrosative stress and peroxynitrite in the pathogenesis of diabetic complications. Emerging new therapeutical strategies. Curr Med Chem. 2005;12(3):267–75.

    PubMed  CAS  Google Scholar 

  52. Figueroa-Romero C, Sadidi M, Feldman EL. Mechanisms of disease: the oxidative stress theory of diabetic neuropathy. Rev Endocr Metab Disord. 2008;9(4):301–14.

    PubMed  CAS  Google Scholar 

  53. Szabo C. Role of nitrosative stress in the pathogenesis of diabetic vascular dysfunction. Br J Pharmacol. 2009;156(5):713–27.

    PubMed  CAS  Google Scholar 

  54. Obrosova IG, Drel VR, Pacher P, Ilnytska O, Wang ZQ, Stevens MJ, Yorek MA. Oxidative-nitrosative stress and poly(ADP-ribose) polymerase (PARP) activation in experimental diabetic neuropathy: the relation is revisited. Diabetes. 2005;54(12):3435–41.

    PubMed  CAS  Google Scholar 

  55. Giannini C, Dyck PJ. Ultrastructural morphometric abnormalities of sural nerve endoneurial microvessels in diabetes mellitus. Ann Neurol. 1994;36:408–15.

    PubMed  CAS  Google Scholar 

  56. Malik RA, Tesfaye S, Thompson SD, Veves A, Boulton AJM, Ward JD. Endoneurial localisation of microvascular damage in human diabetic neuropathy. Diabetologia. 1993;36:454–9.

    PubMed  CAS  Google Scholar 

  57. Tesfaye S, Harris N, Jakubowski J, et al. Impaired blood flow and arterio-venous shunting in human diabetic neuropathy: a novel technique of nerve photography and fluorescein angiography. Diabetologia. 1993;36:1266–74.

    PubMed  CAS  Google Scholar 

  58. Newrick PG, Wilson AJ, Jakubowski J, Boulton AJM, Ward JD. Sural nerve oxygen tension in diabetes. Br Med J. 1986;193:1053–4.

    Google Scholar 

  59. Tesfaye S, Harris N, Wilson RM, Ward JD. Exercise induced conduction velocity increment: a marker of impaired blood flow in diabetic neuropathy. Diabetologia. 1992;35:155–9.

    PubMed  CAS  Google Scholar 

  60. Young MJ, Veves A, Smith JV, Walker MG, Boulton AJM. Restoring lower limb blood flow improves conduction velocity in diabetic patients. Diabetologia. 1995;38:1051–4.

    PubMed  CAS  Google Scholar 

  61. Reja A, Tesfaye S, Harris ND, Ward JD. Is ACE inhibition with lisinopril helpful in diabetic neuropathy? Diabetic Med. 1995;12:307–9.

    PubMed  CAS  Google Scholar 

  62. Malik RA, Williamson S, Abbott CA, Carrington AL, Iqbal J, Schady W, Boulton AJM. Effect of the angiotensin converting enzyme inhibitor trandalopril on human diabetic neuropathy: a randomised controlled trial. Lancet. 1998;352:1978–81.

    PubMed  CAS  Google Scholar 

  63. Pfeifer MA, Weinberg CR, Cook DL, et al. Autonomic neural dysfunction in recently diagnosed diabetic subjects. Diabetes Care. 1984;7:447–53.

    PubMed  CAS  Google Scholar 

  64. Witte DR, Tesfaye S, Chaturvedi N, Eaton SEM, Kempler P, Fuller JH, and the EURODIAB Prospective Complications Study Group. Risk factors for cardiac autonomic neuropathy in Type 1 diabetes mellitus. Diabetologia. 2005;48:164–71.

    PubMed  CAS  Google Scholar 

  65. Diabetes Control and Complications Trial Research Group. The effect of intensive diabetes therapy on the development and progression of neuropathy. Ann Intern Med. 1995;122:561–8.

    Google Scholar 

  66. Spallone V, Ziegler D, Freeman R, Bernardi L, Frontoni S, Pop-Busui R, Stevens M, Kempler P, Hilsted J, Tesfaye S, Low P, Valensi P; on behalf of the Toronto Consensus Panel on Diabetic Neuropathy*. Cardiovascular autonomic neuropathy in diabetes: clinical impact, assessment, diagnosis, and management. Diabetes Metab Res Rev. 2011; doi: 10.1002/dmrr.1239.

  67. Vinik AI, Ziegler D. Diabetic cardiovascular autonomic neuropathy. Circulation. 2007;115:387–97.

    PubMed  Google Scholar 

  68. Gæde P, Vedel P, Larsen N, et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003;348:383–93.

    PubMed  Google Scholar 

  69. Purewal TS, Goss DE, Watkins PJ, Edmonds ME. Lower limb venous pressure in diabetic neuropathy. Diabetes Care. 1995;18:377–81.

    PubMed  CAS  Google Scholar 

  70. The Consensus Committee of the American Autonomic Society and the American Academy of Neurology. Consensus statement on the definition of orthostatic hypotension, pure autonomic failure, and multiple system atrophy. Neurology. 1996;46:1470.

    Google Scholar 

  71. MacLean AR, Allen BV. Orthostatic hypotension and orthostatic tachycardia: treatment with the “head-up” bed. JAMA. 1940;115:2162–7.

    Google Scholar 

  72. Lu CC, Diedrich A, Tung CS, et al. Water ingestion as prophylaxis against syncope. Circulation. 2003;108:2660–5.

    PubMed  Google Scholar 

  73. Low PA, Gilden JL, Freeman R, et al. Efficacy of midodrine vs placebo in neurogenic orthostatic hypotension. A randomized, double-blind multicenter study. Midodrine Study Group. JAMA. 1997;277:1046–51.

    PubMed  CAS  Google Scholar 

  74. Ghrist DG, Brown GE. Postural hypotension with syncope: its successful treatment with ephedrine. Am J Med Sci. 1928;175:336–49.

    Google Scholar 

  75. Heoldtke RD. Treatment of autonomic neuropathy, postural tachycardia and orthostatic syncope with octreotide LAR. Clin Auton Res. 2007;17:334–440.

    Google Scholar 

  76. Hoeldtke RD, Streeten DHP, Streeten DH. Treatment of orthostatic hypotension with erythropoietin. N Engl J Med. 1993;329:611–5.

    PubMed  CAS  Google Scholar 

  77. Horowitz M, Fraser R. Disordered gastric motor function in diabetes mellitus. Diabetologia. 1994;37:543–51.

    PubMed  CAS  Google Scholar 

  78. Lacy BE, Crowell MD, Schettler-Duncan A, et al. The treatment of diabetic gastroparesis with botulinum toxin injection of the pylorus. Diabetes Care. 2004;27:2341–7.

    PubMed  CAS  Google Scholar 

  79. Friedenberg FK, Palit A, Parkman HP, et al. Botulinum toxin A for the treatment of delayed gastric emptying. Am J Gastroenterol. 2008;103:416–23.

    PubMed  CAS  Google Scholar 

  80. Abell T, McCallum R, Hocking M, et al. Gastric electrical stimulation for medically refractory gastroparesis. Gastroenterology. 2003;125:421–8.

    PubMed  Google Scholar 

  81. Lin Z, Forster J, Sarosiek I, McCallum RW. Treatment of diabetic gastroparesis by high-­frequency gastric electrical stimulation. Diabetes Care. 2004;27:1071–6.

    PubMed  Google Scholar 

  82. Sheehy TW. Diabetic gustatory sweating. Am J Gastroenterol. 1991;86:1514–7.

    PubMed  CAS  Google Scholar 

  83. Atkin SL, Brown PM. Treatment of gustatory sweating with topical glycopyrrolate cream. Diabetic Med. 1996;13:493–4.

    PubMed  CAS  Google Scholar 

  84. Shaw JE, Abbott CA, Tindle K, et al. A randomized, controlled trial of topical glycopyrrolate, the first specific treatment for diabetic gustatory sweating. Diabetologia. 1997;40:299–301.

    PubMed  CAS  Google Scholar 

  85. Naumann M. Evidence-based medicine: botulinum toxin in focal hyperhidrosis. J Neurology. 2001;248 Suppl 1:31–3.

    CAS  Google Scholar 

  86. Treede R-D, Jensen TS, Campbell JN, et al. Neuropathic pain: redefinition and a grading system for clinical and research purposes. Neurology. 2008;70:1630–5.

    PubMed  CAS  Google Scholar 

  87. Zelman DC, Brandenburg NA, Gore M. Sleep impairment in patients with painful diabetic peripheral neuropathy. Clin J Pain. 2006;22:681–5.

    PubMed  Google Scholar 

  88. Gore M, Brandenburg NA, Dukes E, et al. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage. 2005;30:374–85.

    PubMed  Google Scholar 

  89. Vileikyte L, Leventhal H, Gonzalez J, et al. Diabetic peripheral neuropathy and depressive symptoms: the association revisited. Diabetes Care. 2005;28:2378–83.

    PubMed  Google Scholar 

  90. Vileikyte L, Peyrot M, Gonzalez JS, et al. Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia. 2009;52:1265–73.

    PubMed  CAS  Google Scholar 

  91. Sankar A, Selvarajah D, Gandhi R, Oleolo M, Emery C, Tesfaye S. Significant impact of mood disturbances of pain perception in painful DPN: time to re-evaluate current practice? Diabetologia. 2010;53 Suppl 1:S446.

    Google Scholar 

  92. Tesfaye S, Boulton AJM, editors. Diabetic neuropathy. Oxford: Oxford University Press. 2009.

    Google Scholar 

  93. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518–22.

    PubMed  Google Scholar 

  94. Daousi C, McFarlane IA, Woodward A, Nurmikko TJ, Bendred PE, Benbow SJ. Chronic painful peripheral neuropathy in an urban community: a control comparison of people with and without diabetes. Diabet Med. 2004;21:976–82.

    PubMed  CAS  Google Scholar 

  95. Tesfaye S, Kempler P. Painful diabetic neuropathy. Diabetologia. 2005;48:805–7.

    PubMed  CAS  Google Scholar 

  96. Oyibo SO, Prasad YDM, Jackson NJ, Boulton AJM. The relationship between blood glucose excursions and painful diabetic peripheral neuropathy: a pilot study. Diabet Med. 2002;19:870–3.

    PubMed  CAS  Google Scholar 

  97. Eaton SE, Harris ND, Ibrahim S, Patel K, Selmi F, Radatz M, Ward JD, Tesfaye S. Differences insural nerve haemodynamics in painful and painless neuropathy. Diabetologia. 2003;46:934–9.

    PubMed  CAS  Google Scholar 

  98. Quattrini C, Harris ND, Malik RA, Tesfaye S. Impaired skin microvascular reactivity in painful diabetic neuropathy. Diabetes Care. 2007;30:655–9.

    PubMed  Google Scholar 

  99. Sorensen L, Molyneaux L, Yue DK. The relationship among pain, sensory loss, and small nerve fibers in diabetes. Diabetes Care. 2006;29:883–7.

    PubMed  Google Scholar 

  100. Selvarajah D, Wilkinson ID, Gandhi R, Emery CJ, Griffiths PD, Tesfaye S. Unique thalamic micerovascular perfusion abnormalities in painful but not painless diabetic polyneuropathy; a clue to the pathogenesis of pain in type1 diabetes mellitus. Diabetes Care. 2011;34(3):718–20.

    PubMed  Google Scholar 

  101. Gandhi R, Marques JLB, Selvarajah D, et al. Painful diabetic neuropathy is associated with greater autonomic dysfunction than painless diabetic neuropathy. Diabetes Care. 2010;33:1585–90.

    PubMed  Google Scholar 

  102. Cruccu G, Sommer C, Anand P, Attal N, Baron R, Garcia-Larrea L, Haanpaa M, Jensen TS, Serra J, Treede RD. EFNS guidelines on neuropathic pain assessment: revised 2009. Eur J Neurol. 2010;17(8):1010–8.

    PubMed  CAS  Google Scholar 

  103. Bouhassira D, Attal N, Fermanian J, Alchaar H, Gautron M, Masquelier E, Rostaing S, Lanteri-Minet M, Collin E, Grisart J, Boureau F. Development and validation of the Neuropathic Pain Symptom Inventory. Pain. 2004;108(3):248–57.

    PubMed  Google Scholar 

  104. Zelman DC, Gore M, Dukes E, Tai KS, 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.

    PubMed  Google Scholar 

  105. Backonja MM, Krause SJ. Neuropathic pain questionnaire—short form. Clin J Pain. 2003;19(5):315.

    PubMed  Google Scholar 

  106. Bennett M. The LANSS Pain Scale: the Leeds assessment of neuropathic symptoms and signs. Pain. 2001;92:147–57.

    PubMed  CAS  Google Scholar 

  107. Melzack R. The short-form McGill pain questionnaire. Pain. 1987;30:191–7.

    PubMed  CAS  Google Scholar 

  108. Vileikyte L, Peyrot M, Bundy EC, et al. The development and validation of a neuropathy and foot ulcer specific quality of life instrument. Diabetes Care. 2003;26:2549–55.

    PubMed  Google Scholar 

  109. Vinik E, Hayes R, Oglesby A, Bastyr E, Barlow P, Ford-Molvik S, Vinik A. The development and validation of the Norfolk QOL-DN a new measure of patients’ perception of the effects of diabetes and diabetic neuropathy. Diabetes Technol Ther. 2005;7(3):497–508.

    PubMed  Google Scholar 

  110. Poole HM, Murphy P, Nurmikko TJ. Development and preliminary validation of the NePIQoL: a quality-of-life measure for neuropathic pain. J Pain Symptom Manage. 2009;37:233–45.

    PubMed  Google Scholar 

  111. Zigmond AS, Snaith RP. The hospital anxiety depression scale. Acta Psychiatr Scand. 1983;67:361–70.

    PubMed  CAS  Google Scholar 

  112. Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010;150:573–81.

    PubMed  Google Scholar 

  113. Sindrup S, Otto M, Finnerup NB, Jensen TS. Antidepressants in the treatment of neuropathic pain. Basic Clin Pharmacol Toxicol. 2005;96:399–409.

    PubMed  CAS  Google Scholar 

  114. Ray WA, Meredith S, Thapa PB, et al. Cyclic antidepressants and the risk of sudden cardiac death. Clin Pharmacol Ther. 2004;75:234–41.

    PubMed  CAS  Google Scholar 

  115. Kajdasz DK, Iyengar S, Desaiah D, et al. Duloxetine for the management of diabetic peripheral neuropathic pain: evidence-based findings from post hoc analysis of three multicentre, randomised, double-blind, placebo-controlled, parallel-group studies. Clin Ther. 2007;29 suppl 2:536–46.

    Google Scholar 

  116. Backonja MM, Beydoun A, Edwards KR, et al. Gabapentin for symptomatic treatment of painful neuropathy in patients with diabetes mellitus. JAMA. 1998;280:1831–6.

    PubMed  CAS  Google Scholar 

  117. Freeman R, Durso-Decruz E, Emir B. Efficacy, safety, and tolerability of pregabalin treatment for painful diabetic peripheral neuropathy: findings from seven randomised, controlled trials across a range of doses. Diabetes Care. 2008;31:1448–54.

    PubMed  CAS  Google Scholar 

  118. Kastrup J, Petersen P, Dejard A, et al. Intravenous lidocaine infusion: a new treatment of chronic painful diabetic neuropathy. Pain. 1987;28:69–75.

    PubMed  CAS  Google Scholar 

  119. Baron R, Mayoral V, Leijon G, Binder A, Steigerwald I, Serpell M. Efficacy and safety of 5% lidocaine (lignocaine) medicated plaster in comparison with pregabalin in patients with postherpetic neuralgia and diabetic polyneuropathy: interim analysis from an open-label, two-stage adaptive, randomized, controlled trial. Clin Drug Investig. 2009;29(4):231–41.

    PubMed  CAS  Google Scholar 

  120. Harati Y, Gooch C, Swenson M, et al. Double-blind randomised trial of tramadol for the treatment of the pain of diabetic neuropathy. Neurology. 1998;50:1842–6.

    PubMed  CAS  Google Scholar 

  121. Gimbel JS, Richards P, Portenoy RK. Controlled-release oxycodone for pain in diabetic neuropathy: a randomised controlled trial. Neurology. 2003;60:927–34.

    PubMed  CAS  Google Scholar 

  122. Bansal D, Bhansali A, Hota D, Chakrabarti A, Dutta P. Amitriptyline vs pregabalin in painful diabetic neuropathy: a randomised double-blind clinical trial. Diabetic Med. 2009;26:1019–26.

    PubMed  CAS  Google Scholar 

  123. Gilron I, Bailey JM, Tu D, et al. Nortriptyline and gabapentin, alone and in combination for neuropathic pain: a double-blind, randomised controlled crossover trial. Lancet. 2009;374(9697):1252–61.

    PubMed  CAS  Google Scholar 

  124. Gilron I, Bailey JM, Tu D, et al. Morphine, gabapentin, or their combination for neuropathic pain. N Engl J Med. 2005;352:1324–34.

    PubMed  CAS  Google Scholar 

  125. Zhang WY, Li Wan Po A. The effectiveness of topically applied capsaicin: a meta-analysis. Eur J Clin Pharm. 1994;46:517–22.

    CAS  Google Scholar 

  126. Ziegler D, Nowak H, Kempler P, Vargha P, Low PA. Treatment of symptomatic diabetic Polyneuropathy with alpha-lipoic acid: a meta-analysis. Diabetic Med. 2004;21:114–21.

    PubMed  CAS  Google Scholar 

  127. Attal N, Cruccu G, Baron R, Haanpää M, Hansson P, Jensen TS, Nurmikko T, European Federation of Neurological Societies. EFNS guidelines on the pharmacological treatment of neuropathic pain: 2010 revision. Eur J Neurol. 2010;17(9):1113–e88.

    PubMed  CAS  Google Scholar 

  128. NICE Clinical Guideline 96: neuropathic pain. The pharmacological management of neuropathic pain in adults in non-specialist settings. March 2010. www.nice.org.uk.

  129. Bril V, England J, Franklin GM, Backonja M, Cohen J, Del Toro D, Feldman E, Iverson DJ, Perkins B, Russell JW, Zochodne D. 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.

    PubMed  CAS  Google Scholar 

  130. Tesfaye S, Vileikyte L, Rayman G, Sindrup S, Perkins B, Baconja M, Vinik A, Boulton A; on behalf of the Toronto Expert Panel on Diabetic Neuropathy*. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev. doi: 10.1002/dmrr.1225.

  131. Abuaisha BB, Constanzi JB, Boulton AJM. Acupuncture for the treatment of chronic painful diabetic neuropathy: a long-term study. Diabetes Res Clin Pract. 1998;39:115–21.

    PubMed  CAS  Google Scholar 

  132. Leonard DR, Farooqu MH, Myers S. Restoration of sensation, reduced pain, and improved balance in subjects with diabetic peripheral neuropathy: a double-blind, randomised placebo-controlled study with monochromatic infrared treatment. Diabetes Care. 2004;27:168–72.

    PubMed  Google Scholar 

  133. Zinman LH, Ngo M, Ng ET, et al. Low-intensity laser therapy for painful symptoms of diabetic sensorimotor polyneuropathy: a controlled trial. Diabetes Care. 2004;27:921–4.

    PubMed  Google Scholar 

  134. Oyibo S, Breislin K, Boulton AJM. Electrical stimulation therapy through stocking electrodes for painful diabetic neuropathy: a double-blind controlled crossover study. Diabet Med. 2004;21:940–4.

    PubMed  CAS  Google Scholar 

  135. Bosi E, Conti M, Vermigli C, et al. Effectiveness of frequency modulated electromagnetic neural stimulation in the treatment of diabetic peripheral neuropathy. Diabetologia. 2005;48(5):817–23.

    PubMed  CAS  Google Scholar 

  136. Reichstein L, Labrenz S, Ziegler D, Martin S. Effective treatment of symptomatic diabetic poyneuropathy by high frequency external muscle stimulation. Diabetologia. 2005;48(5):824–8.

    PubMed  CAS  Google Scholar 

  137. Tesfaye S, Watt J, Benbow SJ, et al. Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy. Lancet. 1996;348:1698–701.

    PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Diabetes Research Unit, Royal Hallamshire Hospital—Sheffield Teaching Hospitals, Glossop Road, Sheffield, South Yorkshire, S10 2JF, UK

    Solomon Tesfaye MD, FRCP

Authors
  1. Solomon Tesfaye MD, FRCP
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Solomon Tesfaye MD, FRCP .

Editor information

Editors and Affiliations

  1. Center, Department of Surgery, Beth Israel Deaconess Medical, 1 Deaconess Road, Boston, 02215, Massachusetts, USA

    Aristidis Veves

  2. , Division of Podiatry, Beth Israel Deaconess Medical Center, 1 Deaconess Road, Boston, 02215, Massachusetts, USA

    John M. Giurini

  3. Center, Department of Surgery, Beth Israel Deaconess Medical, 110 Francis Street, Boston, 02215, Massachusetts, USA

    Frank W. LoGerfo

Rights and permissions

Reprints and permissions

Copyright information

© 2012 Springer Science+Business Media, LLC

About this chapter

Cite this chapter

Tesfaye, S. (2012). Diabetic Polyneuropathy. In: Veves, A., Giurini, J., LoGerfo, F. (eds) The Diabetic Foot. Contemporary Diabetes. Humana Press, Totowa, NJ. https://doi.org/10.1007/978-1-61779-791-0_3

Download citation

  • DOI: https://doi.org/10.1007/978-1-61779-791-0_3

  • Published:

  • Publisher Name: Humana Press, Totowa, NJ

  • Print ISBN: 978-1-61779-790-3

  • Online ISBN: 978-1-61779-791-0

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation