Abstract
The prevalence of diabetes is rising globally and, as a result, its associated complications are also rising. Painful diabetic neuropathy (PDN) is a well-known complication of diabetes and the most common cause of all neuropathic pain. About one-third of all diabetes patients suffer from PDN. It has a huge effect on a person's daily life, both physically and mentally. Despite huge advances in diabetes and neurology, the exact mechanism of pain causation in PDN is still not clear. The origin of pain could be in the peripheral nerves of the central nervous system. In this review, we discuss various possible mechanisms of the pathogenesis of pain in PDN. We discuss the role of hyperglycaemia in altering the physiology of peripheral nerves. We also describe central mechanisms of pain.
Highlights
Diabetes affects 382 million people wordlwide and its prevalence is expected to increase to 592 million by the year 2035 [1]
The central nervous system (CNS) pathway, which is responsible for transmitting only nonnoxious stimuli, was replaced by sprouting Abeta fibres that transmit nonnoxious impulses and release substance P in the dorsal horn, thereby mediating allodynia [45]. This hypothesis was mainly based on experiments that showed that the uptake of the cholera toxin B (CTB) subunit, which is a selective tracer for large myelinated Afibres, terminated in lamina II [46]
Studies have shown a beneficial effect of pain relief with transcranial magnetic stimulation (TMS) and transcranial direct current stimulation, which suggests a reversal of plasticity [58, 59]
Summary
Diabetes affects 382 million people wordlwide and its prevalence is expected to increase to 592 million by the year 2035 [1]. Most studies found no significant difference in gender; Abbot et al [7] reported a slightly higher prevalence of painful symptoms of neuropathy in females (38%) than males (31%). Painful diabetic neuropathy (PDN) symptoms exhibit a symmetrical “stocking and gloves” distribution and are often associated with nocturnal exacerbation. It can be presented from a mild pins and needle sensation to stabbing, burning, unremitting, or even unpleasant electric shock sensation. Some patients present with distressing allodynia and severe pain in the legs This may be so painful that it prevents them from performing their daily activities, thereby impacting their employment and social life. Pain Research and Treatment reported in the literature as “diabetic neuropathic cachexia” [10]
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