scholarly journals Altered pain processing in patients with type 1 and 2 diabetes: systematic review and meta-analysis of pain detection thresholds and pain modulation mechanisms

2020 ◽  
Vol 8 (1) ◽  
pp. e001566
Author(s):  
Eva Sierra-Silvestre ◽  
Mari Somerville ◽  
Leanne Bisset ◽  
Michel W Coppieters

The first signs of diabetic neuropathy typically result from small-diameter nerve fiber dysfunction. This review synthesized the evidence for small-diameter nerve fiber neuropathy measured via quantitative sensory testing (QST) in patients with diabetes with and without painful and non-painful neuropathies. Electronic databases were searched to identify studies in patients with diabetes with at least one QST measure reflecting small-diameter nerve fiber function (thermal or electrical pain detection threshold, contact heat-evoked potentials, temporal summation or conditioned pain modulation). Four groups were compared: patients with diabetes (1) without neuropathy, (2) with non-painful diabetic neuropathy, (3) with painful diabetic neuropathy and (4) healthy individuals. Recommended methods were used for article identification, selection, risk of bias assessment, data extraction and analysis. For the meta-analyses, data were pooled using random-effect models. Twenty-seven studies with 2422 participants met selection criteria; 18 studies were included in the meta-analysis. Patients with diabetes without symptoms of neuropathy already showed loss of nerve function for heat (standardized mean difference (SMD): 0.52, p<0.001), cold (SMD: −0.71, p=0.01) and electrical pain thresholds (SMD: 1.26, p=0.01). Patients with non-painful neuropathy had greater loss of function in heat pain threshold (SMD: 0.75, p=0.01) and electrical stimuli (SMD: 0.55, p=0.03) compared with patients with diabetes without neuropathy. Patients with painful diabetic neuropathy exhibited a greater loss of function in heat pain threshold (SMD: 0.55, p=0.005) compared with patients with non-painful diabetic neuropathy. Small-diameter nerve fiber function deteriorates progressively in patients with diabetes. Because the dysfunction is already present before symptoms occur, early detection is possible, which may assist in prevention and effective management of diabetic neuropathy.

2018 ◽  
Vol 31 (4) ◽  
pp. 253 ◽  
Author(s):  
Samuel Vilar ◽  
Jose Manuel Castillo ◽  
Pedro V. Munuera Martínez ◽  
María Reina ◽  
Manuel Pabón

2019 ◽  
Vol 9 (5) ◽  
pp. 449-460 ◽  
Author(s):  
Calum Gordon ◽  
Alba Barbullushi ◽  
Stefano Tombolini ◽  
Federica Margiotta ◽  
Alessia Ciacci ◽  
...  

Aim: Evidence has revealed a relationship between pain and the observation of limb movement, but it is unknown whether different types of movements have diverse modulating effects. In this immersive virtual reality study, we explored the effect of the vision of different virtual arm movements (arm vs wrist) on heat pain threshold of healthy participants. Patients & methods: 40 healthy participants underwent four conditions in virtual reality, while heat pain thresholds were measured. Visuo–tactile stimulation was used to attempt to modulate the feeling of virtual limb ownership while the participants kept their arms still. Results: Effects on pain threshold were present for type of stimulation but not type of movement. Conclusion: The type of observed movement does not appear to influence pain modulation, at least not during acute pain states.


1986 ◽  
Vol 74 (1) ◽  
pp. 1-9 ◽  
Author(s):  
J.J. Heimans ◽  
F.W. Bertelsmann ◽  
J.C.G.M. Van Rooy

Pain Medicine ◽  
2015 ◽  
Vol 16 (9) ◽  
pp. 1773-1780 ◽  
Author(s):  
Shaheen E. Lakhan ◽  
Dominic N. Velasco ◽  
Deborah Tepper

PAIN Reports ◽  
2017 ◽  
Vol 2 (3) ◽  
pp. e592 ◽  
Author(s):  
Yelena Granovsky ◽  
Hadas Nahman-Averbuch ◽  
Mogher Khamaisi ◽  
Michal Granot

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