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Pain. 2017 Dec;158(12):2340-2353. doi: 10.1097/j.pain.0000000000001034.

Sensory phenotype and risk factors for painful diabetic neuropathy: a cross-sectional observational study.

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aCentral European Institute of Technology, Masaryk University, Brno, Czech Republic bDepartment of Neurology, University Hospital Brno, Brno, Czech Republic cDepartment of Neurology, University of Würzburg, Würzburg, Germany dDepartment of Neurology, University Medical Center, Mainz, Germany eDepartment of Anesthesiology, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany fDivision of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria gDiabetologic Centre, Department of Internal Medicine and Gastroenterology, University Hospital Brno, Brno, Czech Republic hDiabetologic Centre, St. Anne University Hospital, Brno, Czech Republic iDepartment of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic jInstitute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic.


Different sensory profiles in diabetic distal symmetrical sensory-motor polyneuropathy (DSPN) may be associated with pain and the responsiveness to analgesia. We aimed to characterize sensory phenotypes of patients with painful and painless diabetic neuropathy and to assess demographic, clinical, metabolic, and electrophysiological parameters related to the presence of neuropathic pain in a large cohort of well-defined DSPN subjects. This observational cross-sectional multi-center cohort study (performed as part of the ncRNAPain EU consortium) of 232 subjects with nonpainful (n = 74) and painful (n = 158) DSPN associated with diabetes mellitus of type 1 and 2 (median age 63 years, range 21-87 years; 92 women) comprised detailed history taking, laboratory tests, neurological examination, quantitative sensory testing, nerve conduction studies, and neuropathy severity scores. All parameters were analyzed with regard to the presence and severity of neuropathic pain. Neuropathic pain was positively correlated with the severity of neuropathy and thermal hyposensitivity (P < 0.001). A minority of patients with painful DSPN (14.6%) had a sensory profile, indicating thermal hypersensitivity that was associated with less severe neuropathy. Neuropathic pain was further linked to female sex and higher cognitive appraisal of pain as assessed by the pain catastrophizing scale (P < 0.001), while parameters related to diabetes showed no influence on neuropathic pain with the exception of laboratory signs of nephropathy. This study confirms the value of comprehensive DSPN phenotyping and underlines the importance of the severity of neuropathy for the presence of pain. Different sensory phenotypes might be useful for stratification of patients with painful DSPN for analgesic treatment and drug trials.

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