Large and small nerve fiber function in painful diabetic neuropathy

Heimans, Jan J.; Bertelsmann, F.W.; Rooy, John C.G.M. van

doi:10.1016/0022-510x(86)90186-3

Cited by 53 publications

(15 citation statements)

References 25 publications

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“…Based on these phenotypic parallels, a common pathomechanistic pathway becomes conceivable. Significant differences, however, could be detected in pain severity, suggesting more small-fiber involvement in DSPN compared to CIAP [25, 26]. Calculations, furthermore, showed a trend towards significant differences in ONLS scores and mobility tests (P = 0.06; 0.053).…”

Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome, Neurotoxic 1-Deoxysphingolipids and Nervous Tissue Inflammation in Chronic Idiopathic Axonal Polyneuropathy (CIAP)

et al. 2017

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AimChronic idiopathic axonal polyneuropathy (CIAP) is a slowly progressive, predominantly sensory, axonal polyneuropathy, with no aetiology being identified despite extensive investigations. We studied the potential role of the metabolic syndrome, neurotoxic 1-deoxysphingolipids (1-deoxySLs), microangiopathy and inflammation in sural nerve biopsies.MethodsWe included 30 CIAP-patients, 28 with diabetic distal symmetrical polyneuropathy (DSPN) and 31 healthy controls. We assessed standardised scales, tested for the metabolic syndrome, measured 1-deoxySLs in plasma, performed electroneurography and studied 17 sural nerve biopsies (10 CIAP; 7 DSPN).ResultsOne third of the CIAP-patients had a metabolic syndrome, significantly less frequent than DSPN-patients (89%). Although the metabolic syndrome was not significantly more prevalent in CIAP compared to healthy controls, hypercholesterolemia did occur significantly more frequent. 1-deoxySLs were significantly and equally elevated in both patient groups compared to healthy controls. Mean basal lamina thickness of small endoneurial vessels and the number of CD68- or CD8-positive cells in biopsies of CIAP- and DSPN-patients did not differ significantly. However, the number of leucocyte-common-antigen positive cells was significantly increased in CIAP.ConclusionsA non-significant trend towards a higher occurrence of the metabolic syndrome in CIAP-patients compared to healthy controls was found. 1-deoxySLs were significantly increased in plasma of CIAP-patients. Microangiopathy and an inflammatory component were present in CIAP-biopsies.

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Section: Discussionmentioning

confidence: 99%

Metabolic Syndrome, Neurotoxic 1-Deoxysphingolipids and Nervous Tissue Inflammation in Chronic Idiopathic Axonal Polyneuropathy (CIAP)

et al. 2017

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“…It has been known that peripheral nerves consist of larger motor nerve fibers than the autonomic nerve fibers 22. Therefore, patients with peripheral neuropathy might mean that they had already damaged autonomic nerve fibers.…”

Section: Discussionmentioning

confidence: 99%

Gastroesophageal Reflux Disease in Type II Diabetes Mellitus With or Without Peripheral Neuropathy

Lee¹,

Keum²,

Chun³

et al. 2011

J Neurogastroenterol Motil

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Background/AimsPatients with type II diabetes mellitus (DM) were known to have higher prevalence of gastroesophageal reflux disease (GERD). Recent studies have shown that neuropathy has positive role on the development of GERD in type II DM, although its pathogenesis has not been fully understood yet. The aim of this study was to investigate whether neuropathy really contribute to the development of GERD and typical GERD symptoms in patients with type II DM in Korea.MethodsOne hundred and nineteen patients with type II DM who had given informed consents were enrolled. All patients underwent electromyography to check the presence of peripheral neuropathy, face-to-face interview to evaluate their typical GERD symptoms and esophagogastroduodenoscopy to look for the presence of erosive esophagitis. Ninety-five patients were finally included for this study and they were divided according to the presence or absence of the peripheral neuropathy.ResultsThe mean age of 95 patients was 59.3 ± 9.1 years and the mean disease duration of DM was 9.3 ± 5.9 years. Typical GERD symptoms were similarly found in both groups with and without peripheral neuropathy (23.6% vs 22.8%, P = 0.921). Erosive esophagitis was more prevalent in patients with neuropathy than in those without neuropathy (31.5% vs 10.5%, P = 0.022).ConclusionsIn patients with type II DM, peripheral neuropathy is an independent risk factor for the erosive esophagitis. However, peripheral neuropathy did not contribute to the presence of the typical GERD symptoms.

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“…All injections were made over a period of 2 minutes. Venous blood for glucose estimation was taken at 15 minutes before injection (fasting), and 0,5,10, 20, 30, 40, 50, 60 minutes afterwards. Heat pain and cold thresholds (HPT and CT) were obtained with a Marstock thermode attached to the thenar eminence of the non-dominant hand and held in place by a small weight.6 A constant current of 2 A was delivered to the stimulating plate and the test subject indicated the perceived thermal threshold by pressing a switch which reversed the direction of the current and therefore of the temperature change.…”

Section: Methodsmentioning

confidence: 99%

Does acute hyperglycaemia influence heat pain thresholds?

Chan

MacFarlane

Bowsher

et al. 1988

Journal of Neurology, Neurosurgery & Psychiatry

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SUMMARY The influence of acute hyperglycaemia on pain sensation was assessed in eight young adult non-diabetic subjects. Acute hyperglycaemia was induced with IV glucose in a double blind fashion, with IV saline as a control. Pain thresholds were assessed by a painful heat stimulus delivered by a Marstock thermode on the thenar eminence. Heat pain thresholds did not significantly alter during either acute hyperglycaemia or the control saline infusion. Previous work demonstrating a lowering of electrical pain thresholds by hyperglycaemia has therefore not been confirmed using a natural painful stimulus.Experimental work in animals has shown that hyperglycaemia can reduce the antinociceptive potency of morphine.' Morley et al2 have shown that acute hyperglycaemia lowered thresholds to painful electrical stimulation in normal human subjects. These findings are compatible with the hypothesis that hyperglycaemia, or rapid fluxes in blood glucose levels, increase pain sensitivity. They also showed that diabetic subjects had a lower pain tolerance compared with non-diabetic controls. Morley and colleagues conclude from their studies that glucose may modulate opioid receptors in man. A recent editorial called for further work on the association between hyperglycaemia, pain perception, and possible glucose modulation of opioid receptors.3 Electrical stimuli of sufficient intensity to activate nociceptive fibres will perforce generate impulses in every other kind of nerve fibre. Therefore, we favour the use of a noxious heat stimulus, which selectively activates small Ab and C fibres.45 We assessed the influence of hyperglycaemia on pain thresholds using a noxious heat stimulus, delivered by a Marstock thermode.6 Subjects Eight healthy, non-diabetic subjects (4 male), mean age 25 years (range 18-38), were studied. All had normal fasting blood glucose (< 6 mmol/l) and glycosylated haemoglobin values of less than 7% (laboratory reference: 5-8%), and were taking no medications. MethodsThe subjects were studied after an overnight fast and all experiments were conducted in a quiet room with an ambient temperature of 19°C. Two intravenous cannulae were inserted, one in each antecubital fossa. Each subject was tested twice in a randomised, double blind, crossover study to receive either an intravenous bolus of 50 gram glucose in 100 ml or an equivalent volume of normal saline. The alternative injection was given a week later. All injections were made over a period of 2 minutes. Venous blood for glucose estimation was taken at 15 minutes before injection (fasting), and 0,5,10, 20, 30, 40, 50, 60 minutes afterwards. Heat pain and cold thresholds (HPT and CT) were obtained with a Marstock thermode attached to the thenar eminence of the non-dominant hand and held in place by a small weight.6 A constant current of 2 A was delivered to the stimulating plate and the test subject indicated the perceived thermal threshold by pressing a switch which reversed the direction of the current and therefore of the temperature change. The thermo...

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Large and small nerve fiber function in painful diabetic neuropathy

Cited by 53 publications

References 25 publications

Metabolic Syndrome, Neurotoxic 1-Deoxysphingolipids and Nervous Tissue Inflammation in Chronic Idiopathic Axonal Polyneuropathy (CIAP)

Metabolic Syndrome, Neurotoxic 1-Deoxysphingolipids and Nervous Tissue Inflammation in Chronic Idiopathic Axonal Polyneuropathy (CIAP)

Gastroesophageal Reflux Disease in Type II Diabetes Mellitus With or Without Peripheral Neuropathy

Does acute hyperglycaemia influence heat pain thresholds?

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