Translation of symptoms and signs into mechanisms in neuropathic pain

Jensen, Troels Staehelin; Baron, Ralf

doi:10.1016/s0304-3959(03)00006-x

Cited by 428 publications

(260 citation statements)

References 34 publications

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“…Thus, symptoms alone are not discriminant enough to indicate specific aetiologies. Identifying neurological deficits and analysing their topography (both of which are directly related to the nerve lesion itself) is essential for such a purpose (20,28). The absence of associations between symptoms and almost all pain localisations suggests that lesion topography does not influence neuropathic characteristics of pain and should not determine the response to therapy.…”

Section: Discussionmentioning

confidence: 99%

“…In particular, identification of subsyndromes corresponding to various combinations of symptoms (related or not to the aetiology) may contribute to reformation of current therapeutic strategies (7,8,19). The traditional aetiology-based categorisation of neuropathic pain still prevails for clinical, experimental (20,21) and pharmacological studies (1,11,14). Pharmacological studies have evaluated neuropathic pain as a global and uniform symptom.…”

Section: -Introductionmentioning

confidence: 99%

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Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Attal

Fermanian

et al. 2008

Pain

261

145

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Section: Discussionmentioning

confidence: 99%

Section: -Introductionmentioning

confidence: 99%

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Attal

Fermanian

et al. 2008

Pain

261

145

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“…This localization implies that aldose reductase dysfunction does not only alter vascular function, although this observation has led to something of a conundrum with regard to the pathogenic role of the enzyme: demyelination can be a feature of human diabetic neuropathy 28,43 , but diabetic rodents rarely exhibit marked Schwann cell pathology Diabetic neuropathy classically presents as a sensory neuropathy that results from damage to both large and small fibres, which can cause negative symptoms, such as loss of sensation to touch, vibration, pinprick, hot and cold 177,178 , and positive symptoms, such as paradoxical pain and hypersensitivity [179][180][181][182][183] . Negative and positive symptoms are both most pronounced distally, with a characteristic stocking-glove pattern (see the figure).…”

Section: Schwann Cells In Diabetic Neuropathymentioning

confidence: 99%

Schwann cell interactions with axons and microvessels in diabetic neuropathy

et al. 2017

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The incidence of diabetes mellitus has increased dramatically over the past two to three decades. According to the International Diabetes Federation Diabetes Atlas, 415 million people worldwide had diabetes in 2015, and this number is expected to grow by 5% annually, predominantly as a result of increasing prevalence of type 2 diabetes. Furthermore, an estimated 100 million Europeans and 80 million Americans have impaired glucose tolerance or prediabetes. Few people die from acute diabetes in countries with comprehensive health care systems, but the disease is inflicting a huge medical, social and economic burden on society owing to the need for lifelong treatment of its systemic consequences and the insidious development of multi-organ damage.Peripheral neuropathy (BOXES 1,2) is a common but often neglected complication of long-term diabetes, and the lack of treatment options reflects an incomplete understanding of the pathogenic mechanisms. Hyperglycaemia is generally accepted as the primary pathogenic insult in type 1 and type 2 diabetic neuropathy, although roles are emerging for other factors, such as impaired insulin signalling, hypertension and dyslipidaemia (particularly for type 2 diabetes), which might precede overt hyperglycaemia 1 . Many preclinical studies, and occasional clinical studies, have indicated that diabetic neuropathy -like diabetic nephropathy and retinopathy -results from microvascular disease, with a focus on axonal degeneration as a consequence of ischaemia and/or hypoxia. This mechanism, however, is likely to be only one aspect of a more complex pathogenesis.The earliest descriptions of pathology in diabetic neuropathy indicated that Schwannopathy accompanied axonal degeneration. The majority of clinical and basic research in diabetic neuropathy since then has focused on the effects on neurons. However, accumulating data from research into the development and regeneration of the PNS has identified Schwann cells as equally indispensable components that maintain neuronal structure and function, nourish axons, and promote survival and growth upon injury. The early reports from 1979 that demonstrated morphological changes in Schwann cells in human diabetic neuropathy 2 are now supported by an increased awareness of molecular alterations in Schwann cells during diabetes 3 . Schwann cells express a wide range of receptors and, when they sense insults or danger signals, they upregulate synthesis and secretion of factors that stimulate neuroprotection, regrowth and remyelination, or factors that aggravate disease phenotypes 4 . The most recent studies have demonstrated that Schwann cells regulate many aspects of axonal function, so that disruption of their metabolism by diabetes results in the accumulation of neurotoxic intermediates and compromises production of neuronal support factors, contributing to axonal degeneration, endothelial dysfunction and diabetic neuropathy. Abstract | The prevalence of diabetes worldwide is at pandemic levels, with the number of patients increasing by 5% annu...

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“…Attempts are made to classify patients on the basis of symptoms, signs, or patterns of somatosensory abnormalities [139][140][141]. Those might reflect the underlying pathological mechanisms [142] and might, therefore, be related to different treatment responses [137,143].…”

Section: Future Perspectivesmentioning

confidence: 99%

Effects of Acupuncture on Sensory Perception: A Systematic Review and Meta-Analysis

Baeumler¹,

Fleckenstein²,

Takayama

et al. 2015

Deutsche Zeitschrift für Akupunktur

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Background: The effect of acupuncture on sensory perception has never been systematically reviewed; although, studies on acupuncture mechanisms are frequently based on the idea that changes in sensory thresholds reflect its effect on the nervous system. Methods: Pubmed, EMBASE and Scopus were screened for studies investigating the effect of acupuncture on thermal or mechanical detection or pain thresholds in humans published in English or German. A meta-analysis of high quality studies was performed. Results: Out of 3007 identified articles 85 were included. Sixty five studies showed that acupuncture affects at least one sensory threshold. Most studies assessed the pressure pain threshold of which 80% reported an increase after acupuncture. Significant short-and long-term effects on the pressure pain threshold in pain patients were revealed by two meta-analyses including four and two high quality studies, respectively. In over 60% of studies, acupuncture reduced sensitivity to noxious thermal stimuli, but measuring methods might influence results. Few but consistent data indicate that acupuncture reduces pin-prick like pain but not mechanical detection. Results on thermal detection are heterogeneous. Sensory threshold changes were equally frequent reported after manual acupuncture as after electroacupuncture. Among 48 sham-controlled studies, 25 showed stronger effects on sensory thresholds through verum than through sham acupuncture, but in 9 studies significant threshold changes were also observed after sham acupuncture. Overall, there is a lack of high quality acupuncture studies applying comprehensive assessments of sensory perception.

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Translation of symptoms and signs into mechanisms in neuropathic pain

Cited by 428 publications

References 34 publications

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Neuropathic pain: Are there distinct subtypes depending on the aetiology or anatomical lesion?

Schwann cell interactions with axons and microvessels in diabetic neuropathy

Effects of Acupuncture on Sensory Perception: A Systematic Review and Meta-Analysis

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