Importance of pain evaluation for more accurate diagnosis of painful diabetic polyneuropathy

Abstract

Pain is a common problem in diabetic neuropathy, but relatively little has been published regarding the extent to which it needs to be addressed in clinical practice. Objective. To assess neuropathic pain profile and its association with quantitative sensory testing in painful diabetic polyneuropathy. Material and methods. Altogether, 61 consecutive diabetic inpatients with symmetric neuropathic complaints were enrolled. Clinical neurological examination and quantitative sensory testing (QST) were performed. Patients were interviewed using the Neuropathic Pain Scale (NPS) and filled in the McGill Pain Questionnaire (MPQ). Results. Of all patients, 49 (80.3%) had clinical diabetic polyneuropathy. Only 17 of these patients complained of lower extremity pain on an initial interview, while 27 marked it in the MPQ. The intensity of deep and superficial pain did not differ, but patients rated deep pain as more unpleasant than superficial (6.27±2.37 vs. 4.30±1.42 on the NPS, P=0.034). Superficial pain NPS items tended to correlate with QST results, while deep pain items did not. Only female gender (OR=7.87) and lower glycosylated hemoglobin level (OR=0.65) were predictive of pain in case of diabetic neuropathy. Conclusions. Standard pain questionnaires were useful in identifying pain sufferers. At the same intensity, deep neuropathic pain was more unpleasant than superficial. Pain manifestation was associated with female gender and lower level of glycosylated hemoglobin.

Validation of the Questionnaire for Symptom Assessment in Pain disorders for Back pain patients (Q‐SAP)

“…Furthermore, Gierthmühlen et al indicated no correlation for self‐reported thermal pain or self‐reported numbness and the equivalent parameter upon QST. Petrikonis et al only found ‘… a tendency of correlation…’ for the superficial pain items derived from the Neuropathic Pain Scale with QST, but not for deep pain characteristics (Petrikonis et al., 2010). Therefore, it can be assumed that QST‐parameters and self‐reported symptoms accord to some extent, but the results of this study do not allow to generalize that QST and questionnaires assess the same psycho‐somatosensory aspects.…”

Painful Diabetic Neuropathy (PDN): An Update for Clinicians

“…Common painful symptoms also include sharp or lancinating pain attacks, allodynia, cramping and gnawing. 10,11 These symptoms are commonly used in rating scales and standard pain questionnaires to assess frequency and severity of painful symptoms, and treatment response. Moreover, since each type of pain is believed to be caused by a different pathophysiological mechanism, therefore, each neuropathic pain medication might have a different effect on sensory symptoms.…”

“…Incorporating standard pain questionnaires in clinical evaluation will also aid earlier diagnosis and better management in these patients. 11 In our study, 13 we used the DN4 questionnaire, which has been validated as a reliable screening tool for neuropathic pain in diabetic patients. 14 The questionnaires can be used to screen and differentiate between neuropathic and non-neuropathic pain.…”

0.025% Capsaicin Gel for the Treatment of Painful Diabetic Neuropathy: A Randomized, Double‐Blind, Crossover, Placebo‐Controlled Trial

“…Common pain symptoms are sharp, lancinating, burning, prickling, deep aching, cramping, and gnawing. Upon examination, hyperalgesia and allodynia were frequently found . Therefore, it is the most common cause of neuropathic pain .…”

“…Upon examination, hyperalgesia and allodynia were frequently found. 3,4 Therefore, it is the most common cause of neuropathic pain. 5 Patients with PDN have a lower quality of life, especially the physical aspect.…”