Abstract
BackgroundSubjects with diabetes mellitus (DM) develop gait dysfunction contributing to falls, reluctance to perform activities and injuries. Neuropathic pain (NeP) related to diabetic peripheral neuropathy (DPN) is associated with increased gait variability that may contribute to gait dysfunction. We used a portable device (GaitMeter™) and related gait and balance measures to measure gait parameters in painful DPN (PDPN) subjects prior to and during analgesia. Our hypothesis was that PDPN subjects would have decreased gait step variability when receiving pharmacological relief of NeP.MethodsDPN subjects with at least moderate NeP were assessed in a randomized, double-blind crossover study of pregabalin versus placebo. The outcome measure was variability in step length and step velocity. Testing for Timed Get-Up-and-Go Test, Tinetti Mobility Scales, Sway Testing, a Physiological Profile Approach, and fall-related surveys were also performed. DPN severity was quantified using the Utah Early Neuropathy Score.ResultsPDPN subjects developed increased, rather than decreased, step length and step velocity variability during pregabalin treatment. There were no significant differences between cohorts for other physiological gait and balance testing. Non-significant NeP relief occurred in the pregabalin phase of study as compared with placebo. There was a negative relationship for step length with pain severity.ConclusionAnalgesia did not decrease gait variability in PDPN patients, and in fact, increased gait variability was seen during pregabalin treatment. Other important relationships of gait dysfunction with PDPN should be sought.Electronic supplementary materialThe online version of this article (doi:10.1186/1743-0003-11-125) contains supplementary material, which is available to authorized users.
Highlights
A strong predictor for falling is the presence of diabetes mellitus (DM) [1,2]
In contrast to our primary hypothesis, the degree of variability in both step length and step velocity significantly increased for subjects receiving pregabalin for comparison of baseline and final visits (Bartlett-Box tests, χ2 = 5.139.27, p < 0.025)
Step length variability did not change during the placebo intervention (Bartlett-Box test, χ2 = 1.23,p = NS), step velocity variability decreased during the placebo intervention (Bartlett-Box test, χ2 = 17.07, p < 0.001)
Summary
Falling may occur in DM patients due to its many systemic complications including hypoglycaemia, orthostatic hypotension, obesity, cardiovascular disease, vestibular dysfunction, visual impairment, cognitive impairment [3], and age-related decline. Another important contributor may be diabetic peripheral neuropathy (DPN), present in up to half of DM. Gait variability, defined as the extent to which gait parameters such as step length or step velocity diverge from a mean value, has been previously investigated by our group with reference to PDPN. Neuropathic pain (NeP) related to diabetic peripheral neuropathy (DPN) is associated with increased gait variability that may contribute to gait dysfunction.
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