Hyperalgesia to noxious stimuli is accompanied by increased spinal cyclooxygenase (COX)-2 protein in diabetic rats. The present studies were initiated to establish causality between increased spinal COX-2 activity and hyperalgesia during diabetes and to assess the potential involvement of polyol pathway activity in the pathogenesis of spinally mediated hyperalgesia. Rats with 1, 2, or 4 weeks of streptozotocin-induced diabetes exhibited significantly increased levels of spinal COX-2 protein and activity, along with exaggerated paw flinching in response to 0.5% paw formalin injection. Increased flinching of diabetic rats was attenuated by intrathecal pretreatment with a selective COX-2 inhibitor immediately before formalin injection, confirming the involvement of COX-2 activity in diabetic hyperalgesia. Chronic treatment with insulin or ICI222155, an aldose reductase inhibitor (ARI) previously shown to prevent spinal polyol accumulation and formalinevoked hyperalgesia in diabetic rats, prevented elevated spinal COX-2 protein and activity in diabetic rats. In contrast, the ARI IDD676 had no effect on spinal polyol accumulation, elevated spinal COX-2, or hyperalgesia to paw formalin injection. In the spinal cord, aldose reductase immunoreactivity was present solely in oligodendrocytes, which also contained COX-2 immunoreactivity. Polyol pathway flux in spinal oligodendrocytes provides a pathogenic mechanism linking hyperglycemia to hyperalgesia in diabetic rats. Diabetes 56: [1569][1570][1571][1572][1573][1574][1575][1576] 2007 A proportion of diabetic patients experience chronic pain that severely degrades their quality of life. The pathogenesis of painful diabetic neuropathy is unclear, and treatment options are currently limited to palliatives that do not target a pathogenic mechanism specific to painful diabetic neuropathy and provide limited efficacy before side effects become intolerable (1). Experimental models of diabetic neuropathy can spur development of novel therapies by providing an understanding of how diabetes alters sensory processing.Diabetic rats display abnormal pain-associated behaviors, measured as exaggerated responses to painful stimuli (hyperalgesia) or nocifensive responses to normally innocuous stimuli (allodynia). Hyperalgesia to paw formalin injection (2,3) and allodynia to tactile stimulation of the paw (4) develop within weeks of induction of hyperglycemia, and, as overt structural pathology in peripheral nerves is minimal, attention has focused on biochemical disorders that could exaggerate sensory processing.The formalin test is used to investigate spinal sensitization in animals (5) and allows investigation of sensory processing beyond peripheral nociceptive pathways. Diabetic rats exhibit increased nocifensive behavior during periods of the formalin test associated with spinal sensitization (6,7) in concert with paradoxically decreased spinal release of excitatory neurotransmitters (8,9). This suggests that hyperalgesia is not caused by increased primary afferent input and, toge...