Reduction of Pressure Pain Sensitivity as Novel Non-pharmacological Therapeutic Approach to Type 2 Diabetes: A Randomized Trial

Abstract

BackgroundAutonomic nervous system dysfunction (ANSD) is known to affect glucose metabolism in the mammalian body. Tradition holds that glucose homeostasis is regulated by the peripheral nervous system, and contemporary therapeutic intervention reflects this convention.ObjectivesThe present study tested the role of cerebral regulation of ANSD as consequence of novel understanding of glucose metabolism and treatment target in type 2 diabetes (T2D), suggested by the claim that the pressure pain sensitivity (PPS) of the chest bone periosteum may be a measure of cerebral ANSD.DesignIn a randomized controlled trial of 144 patients with T2D, we tested the claim that 6 months of this treatment would reduce PPS and improve peripheral glucose metabolism.ResultsIn the active treatment group, mean glycated hemoglobin A1c (HbA1c) declined from 53.8 to 50.5 mmol/mol (intragroup p = 0.001), compared with the change from 53.8 to 53.4 mmol/mol in the control group, with the same level of diabetes treatment but not receiving the active treatment (between group p = 0.036). Mean PPS declined from 76.6 to 56.1 units (p < 0.001) in the active treatment group and from 77.5 to 72.8 units (p = 0.02; between group p < 0.001) in the control group. Changes of PPS and HbA1c were correlated (r = 0.37; p < 0.001).ConclusionWe conclude that the proposed approach to treatment of T2D is a potential supplement to conventional therapy.Clinical Trial Registration:www.clinicaltrials.gov (NCT 03576430).

Pressure pain sensitivity: A new stress measure in children and adolescents with type 1 diabetes?

“…To summarize, we found a positive correlation between PPS and HbA1c in the old age group and unexpectedly negative correlations at the first visit between PPS and cortisol and PPS and PSS, the latter being present in the young age group. The negative and missing correlations contrast the findings of Ballegaard et al [ 3 ] who in adults found significant correlations between PPS and physiological markers of stress (heart rate, blood pressure, pressure rate product), regulation of glucose metabolism in adults with type 2 diabetes[ 5 - 7 ], survival in persons with ischemic heart disease[ 8 ] and questionnaires regarding mental and physical health[ 4 ]. Interestingly, we found that the younger males scored higher than the younger females but no differences among the older participants.…”

“…The measurement was also stopped when a noxious withdrawal reflex (NWR) was observed, or if there was an activation of an alarm at maximum pressure (= 30 on PPS scale). PPS-score ranges from 30-100 with values ≥ 60 being the cut-off point for high level of stress in adults, based on receiver operating characteristic curves[ 4 , 5 ]. Salivary cortisol was analyzed with radioimmunoassay and HbA1c collected from medical files.…”

In Type 2 Diabetes Mellitus, normalization of hemoglobin A1c accompanies reduced sensitivity to pressure at the sternum

“…It remains unknown to which extent the phenomenon of elevated sensitivity of pain to pressure at the chest bone called pressure or pain sensitivity, PPS (Ballegaard et al, 2014 )] may be a general sign of disrupted homeostasis associated with elevated sympathetic tonus of the ANS. In a previous study, Faber et al ( 2021 ) tested the specific claim that the PPS of the chest bone periosteum may reflect the degree of disruption of the ANS. In a randomized controlled trial of 144 individuals with T2DM, the authors questioned whether 6 months of a specific supplemental non-pharmacological treatment would reduce elevated PPS measures and improve peripheral glucose metabolism.…”

“…In a randomized controlled trial of 144 individuals with T2DM, the authors questioned whether 6 months of a specific supplemental non-pharmacological treatment would reduce elevated PPS measures and improve peripheral glucose metabolism. The authors observed that PPS and HbA1c measures underwent a correlated decline and concluded that the proposed supplement to pharmacological treatment of T2DM could be an effective addition to conventional therapy (Faber et al, 2021 ).…”

Editorial: New challenges and future perspectives in autonomic neuroscience

“…Regarding metabolism, an interesting study conducted by Faber et al sheds light on the role of the autonomic nervous system in glucose metabolism. Recent independent research has also shown that Pressure Pain Sensitivity (PPS), a parameter that measures the maximum pain and discomfort sensation at the chest bone, in response to a gradually increased pressure during a period of 3–5 s, could serve as an indicator of ANS activity, particularly reflecting the level of ANS disruption (Faber et al, 2021 ). Considering the significance of the ANS in regulating glucose levels, especially in relation to HbA1c values that mirror the glycaemic control status over the previous 2–3 months (Kohzuma et al, 2021 ), the use of PPS bears paramount clinical importance.…”