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Sierra-Silvestre E, Somerville M, Bisset L, Coppieters MW. Altered pain processing in patients with type 1 and 2 diabetes: systematic review and meta-analysis of pain detection thresholds and pain modulation mechanisms. BMJ Open Diabetes Res Care 2020; 8:8/1/e001566. [PMID: 32868312 PMCID: PMC7462232 DOI: 10.1136/bmjdrc-2020-001566] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 06/24/2020] [Accepted: 07/06/2020] [Indexed: 12/15/2022] Open
Abstract
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.
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Affiliation(s)
- Eva Sierra-Silvestre
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Faculty of Human Movement Sciences, Free University Amsterdam, Amsterdam, The Netherlands
| | - Mari Somerville
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
| | - Leanne Bisset
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
| | - Michel W Coppieters
- Menzies Health Institute Queensland, Griffith University, Nathan, Queensland, Australia
- Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
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Lorusso L, Salerno M, Sessa F, Nicolosi D, Longhitano L, Loreto C, Carotenuto M, Messina A, Monda V, Villano I, Cibelli G, Valenzano A, Monda M, Murabito P, Mollica MP, Messina G, Viggiano A. Autoalgometry: An Important Tool for Pressure Pain Threshold Evaluation. J Clin Med 2018; 7:jcm7090273. [PMID: 30213091 PMCID: PMC6162811 DOI: 10.3390/jcm7090273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2018] [Revised: 09/07/2018] [Accepted: 09/10/2018] [Indexed: 11/16/2022] Open
Abstract
The term "pain threshold" refers to the measurement of the intensity of a physical stimulus that evokes pain. To estimate the pain threshold, a mechanical or electrical stimulus with increasing intensity is usually applied until the subject under evaluation refers to a pain sensation. This study aims to evaluate the autoalgometric pain threshold as a perfect technique to determine the effects of stimulation rate in relation to both gender and the site of stimulation. In this experimental model, pressure algometry was applied: the subject under evaluation pushed a finger against a small round metal tip, producing and at the same time controlling the intensity of the noxious stimulus. Through autoalgometry, the stimulus intensity was recorded over time, measuring the force change rate applied and studying the subject's behavior on approaching pain. This test was performed with 50 healthy volunteers on two days, applying a fast or slow rate of stimulation. The results described demonstrate that there is a positive correlation between the pressure increase rate and the pressure threshold evaluation. In light of these findings, autoalgometry can be proposed as an objective measure of pressure pain threshold for clinical and research use.
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Affiliation(s)
- Letizia Lorusso
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy.
| | - Monica Salerno
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
| | - Francesco Sessa
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
| | - Daniela Nicolosi
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95131 Catania, Italy.
| | - Lucia Longhitano
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95131 Catania, Italy.
| | - Carla Loreto
- Department of Biomedical and Biotechnological Sciences, University of Catania, 95131 Catania, Italy.
| | - Marco Carotenuto
- Clinic of Child and Adolescent Neuropsychiatry, Department of Mental Health, Physical and Preventive Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Antonietta Messina
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Vincenzo Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Ines Villano
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Giuseppe Cibelli
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
| | - Anna Valenzano
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
| | - Marcellino Monda
- Department of Experimental Medicine, Section of Human Physiology and Unit of Dietetic and Sport Medicine, University of Campania "Luigi Vanvitelli", 80138 Naples, Italy.
| | - Paolo Murabito
- Department of Surgery and Surgical Medical Specialties, University of Catania, 95131 Catania, Italy.
| | - Maria Pina Mollica
- Department of Biology, University of Naples Federico II, 80138 Naples, Italy.
| | - Giovanni Messina
- Department of Clinical and Experimental Medicine, University of Foggia, 71122 Foggia, Italy.
| | - Andrea Viggiano
- Department of Medicine, Surgery and Dentistry "Scuola Medica Salernitana", University of Salerno, 84081 Baronissi, Italy.
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