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Neuropathic pain in diabetic polyneuropathy: a 5-year prospective study
Peter Kolind Brask-Thomsen1,2,3, Mustapha Itani4, Páll Karlsson1,5
1Danish Pain Research Center, Department of Clinical Medicine, Aarhus University, Aarhus N, Denmark.
Pain
|May 13, 2025
Summary
Diabetic polyneuropathy pain (P-DPN) increased over five years. Factors like female sex and reduced warm sensitivity predict pain development, while lower BMI and higher sensory sensitivity predict pain relief.
Area of Science:
- Neurology
- Diabetology
- Pain Medicine
Background:
- Diabetic polyneuropathy (DPN) is a common complication of type 2 diabetes.
- Prospective studies on the development and resolution of neuropathic pain in DPN are limited.
- Understanding pain dynamics in DPN is crucial for effective patient management.
Purpose of the Study:
- To investigate the longitudinal development of painful DPN (P-DPN) over five years.
- To identify factors associated with the onset and cessation of neuropathic pain in patients with DPN.
- To analyze the progression of DPN and associated pain in a cohort of newly diagnosed type 2 diabetes patients.
Main Methods:
- A 5-year prospective follow-up study of 102 patients with probable DPN at baseline, from a Danish nationwide cohort of 5514 type 2 diabetes patients.
- Detailed phenotyping including bedside sensory examination, quantitative sensory testing (QST), skin biopsies, and nerve conduction studies at baseline and follow-up.
- Assessment of P-DPN development and pain relief based on established criteria and patient-reported outcomes.
Main Results:
- The prevalence of probable P-DPN increased from 11.5% at baseline to 14.8% at follow-up.
- Among patients with non-painful DPN at baseline, 38.2% developed pain at follow-up.
- Pain development was linked to female sex, lower warm sensory sensitivity, and reduced sural nerve conduction.
- Pain relief was associated with lower BMI, lower cholesterol, and higher sensitivity to cold, mechanical, and vibratory stimuli.
Conclusions:
- Neuropathic pain in diabetic polyneuropathy is dynamic, with a significant proportion of patients developing or resolving pain over five years.
- Specific baseline characteristics, including sensory function and demographic factors, can predict the development or cessation of neuropathic pain.
- These findings highlight the importance of detailed phenotyping and longitudinal assessment in managing DPN and its associated pain.
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