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

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Cross-sectional observational study in a cohort of 232 diabetic polyneuropathy patients confirmed higher severity of neuropathy and predominant loss-of-function sensory profile in painful cases.

Abstract

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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Grading the severity of chronic pain.

Michael Von Korff, Johan Ormel, Francis Keefe … (1992)

This research develops and evaluates a simple method of grading the severity of chronic pain for use in general population surveys and studies of primary care pain patients. Measures of pain intensity, disability, persistence and recency of onset were tested for their ability to grade chronic pain severity in a longitudinal study of primary care back pain (n = 1213), headache (n = 779) and temporomandibular disorder pain (n = 397) patients. A Guttman scale analysis showed that pain intensity and disability measures formed a reliable hierarchical scale. Pain intensity measures appeared to scale the lower range of global severity while disability measures appeared to scale the upper range of global severity. Recency of onset and days in pain in the prior 6 months did not scale with pain intensity or disability. Using simple scoring rules, pain severity was graded into 4 hierarchical classes: Grade I, low disability--low intensity; Grade II, low disability--high intensity; Grade III, high disability--moderately limiting; and Grade IV, high disability--severely limiting. For each pain site, Chronic Pain Grade measured at baseline showed a highly statistically significant and monotonically increasing relationship with unemployment rate, pain-related functional limitations, depression, fair to poor self-rated health, frequent use of opioid analgesics, and frequent pain-related doctor visits both at baseline and at 1-year follow-up. Days in Pain was related to these variables, but not as strongly as Chronic Pain Grade. Recent onset cases (first onset within the prior 3 months) did not show differences in psychological and behavioral dysfunction when compared to persons with less recent onset. Using longitudinal data from a population-based study (n = 803), Chronic Pain Grade at baseline predicted the presence of pain in the prior 2 weeks. Chronic Pain Grade and pain-related functional limitations at 3-year follow-up. Grading chronic pain as a function of pain intensity and pain-related disability may be useful when a brief ordinal measure of global pain severity is required. Pain persistence, measured by days in pain in a fixed time period, provides useful additional information.

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Factor structure, reliability, and validity of the Pain Catastrophizing Scale.

A. Osman, F X Barrios, B Kopper … (1997)

The Pain Catastrophizing Scale (PCS; Sullivan et al., Psychol. Assess. 7, 524-532, 1995) has recently been developed to assess three components of catastrophizing: rumination, magnification, and helplessness. We conducted three studies to evaluate the factor structure, reliability, and validity of the PCS. In Study I, we conducted principal-components analysis with oblique rotation to replicate the three factors of the PCS. Gender differences on the original PCS subscales were also analyzed. In Study II, we conducted confirmatory factor analyses to evaluate the adequacy of fit of four alternative models. We also evaluated evidence for concurrent and discriminant validity. In Study III, we evaluated the ability of the PCS and subscales to differentiate between the responses of clinic (students seeking treatment) and nonclinic undergraduate samples. Also, in the clinic sample, we evaluated evidence of concurrent and predictive validity for the PCS. The internal consistency reliability indices for the total PCS and subscales were examined in all three studies. Limitations and future directions are discussed.

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Reliability and validity of the modified Toronto Clinical Neuropathy Score in diabetic sensorimotor polyneuropathy

V. Bril, S Tomioka, R. Buchanan … (2009)

Introduction A reliable and valid clinical tool to capture symptoms and signs of diabetic sensorimotor polyneuropathy (DSP) for use in clinical research trials is urgently needed. The validated Toronto Clinical Neuropathy Score (TCNS) was modified to improve sensitivity to early DSP changes. We aimed to assess the reproducibility of this modified tool, the mTCNS and to determine its validity relative to the precursor TCNS. Methods Sixty-five patients (six Type 1, 59 Type 2 diabetes) with diabetes duration 13 ± 8 years were accrued from four study sites and examined on 2 days for internal consistency and inter- and intra-rater reliability of the mTCNS. In the absence of a single quantitative gold-standard measure for DSP, results of the mTCNS were compared with the precursor TCNS for the purpose of estimating validity. Results Internal consistency of the two domains within the mTCNS was good (Cronbach's alpha 0.78). Very good inter-rater reliability for the mTCNS was demonstrated by an intra-class correlation coefficient for the mTCNS of 0.87 (95% confidence interval, 0.79–0.91), which was similar in magnitude to that of the TCNS (0.83; 95% confidence interval, 0.75–0.89). Intra-rater reliability testing of the mTCNS showed moderate to good correlation for individual symptoms and sensory tests (Cohen's kappa values of 0.54–0.73). The mTCNS shared moderate correlation with the precursor TCNS (Pearson correlation coefficient, 0.58). Discussion The mTCNS, a clinical score with higher face validity for tracking mild to moderate DSP, has sufficient reliability and validity relative to its precursor TCNS for use in clinical research.

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Journal

Journal ID (nlm-ta): Pain

Journal ID (iso-abbrev): Pain

Journal ID (coden): JPAIN

Journal ID (pmc): Pain

Journal ID (publisher-id): JOP

Title: Pain

Publisher: Wolters Kluwer (Philadelphia, PA )

ISSN (Print): 0304-3959

ISSN (Electronic): 1872-6623

Publication date (Electronic): 03 August 2017

Publication date (Print): December 2017

Volume: 158

Issue: 12

Pages: 2340-2353

Affiliations

[a ]Central European Institute of Technology, Masaryk University, Brno, Czech Republic

[b ]Department of Neurology, University Hospital Brno, Brno, Czech Republic

[c ]Department of Neurology, University of Würzburg, Würzburg, Germany

[d ]Department of Neurology, University Medical Center, Mainz, Germany

[e ]Department of Anesthesiology, Centre for Interdisciplinary Pain Medicine, University Hospital Würzburg, Würzburg, Germany

[f ]Division of Genetic Epidemiology, Department of Medical Genetics, Molecular and Clinical Pharmacology, Medical University of Innsbruck, Innsbruck, Austria

[g ]Diabetologic Centre, Department of Internal Medicine and Gastroenterology, University Hospital Brno, Brno, Czech Republic

[h ]Diabetologic Centre, St. Anne University Hospital, Brno, Czech Republic

[i ]Department of Internal Medicine, Geriatrics and Practical Medicine, University Hospital Brno, Brno, Czech Republic

[j ]Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic

Author notes

[* ]Corresponding author. Address: Central European Institute of Technology, Masaryk University, 625 00 Brno, Czech Republic. Tel.: 00420532232501. E-mail address: bednarik.josef@ 123456fnbrno.cz (J. Bednarik).

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Publisher ID: PAIN-D-17-00413 Accession ID: 00009

DOI: 10.1097/j.pain.0000000000001034

PMC ID: 5690294

PubMed ID: 28858986

SO-VID: 76fddc6b-b8c2-4824-b6f5-124a33a901ae

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This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

History

Date received : 28 April 2017

Date revision received : 27 July 2017

Date accepted : 28 July 2017

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: painful diabetic neuropathy,sensory profile,quantitative sensory testing,risk factors

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ScienceOpen disciplines: Anesthesiology & Pain management

Keywords: painful diabetic neuropathy, sensory profile, quantitative sensory testing, risk factors

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

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Most cited references 25

Grading the severity of chronic pain.

Factor structure, reliability, and validity of the Pain Catastrophizing Scale.

Reliability and validity of the modified Toronto Clinical Neuropathy Score in diabetic sensorimotor polyneuropathy

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