Differential involvement of myelinated and unmyelinated nerve fibers in painful diabetic polyneuropathy.

Abstract:

BACKGROUND:We aimed at evaluating the differential involvement of large myelinated Aβ-, small myelinated Aδ-, and unmyelinated C-fibers in patients with diabetic polyneuropathy and how they contribute to neuropathic pain. METHODS:We collected clinical and diagnostic test variables in 133 consecutive patients with diabetic polyneuropathy. All patients underwent Aβ-fiber mediated nerve conduction study, Aδ-fiber mediated laser-evoked potentials and skin biopsy mainly assessing unmyelinated C-fibers. RESULTS:Pure large-fiber and small-fiber polyneuropathy were relatively uncommon; conversely mixed-fiber polyneuropathy was the most common type of diabetic polyneuropathy (74%). The frequency of neuropathic pain was similar in the three different polyneuropathies. Ongoing burning pain and dynamic mechanical allodynia were similarly associated with specific small-fiber related variables. CONCLUSIONS:Diabetic polyneuropathy mainly manifests as a mixed-fiber polyneuropathy, simultaneously involving Aβ-, Aδ-, and C-fibers. In most patients, neuropathic pain is distinctly associated with small-fiber damage. The evidence that the frequency of neuropathic pain does not differ across pure large-, pure small-, and mixed-fiber polyneuropathy, raises the possibility that in patients with pure large-fiber polyneuropathy nociceptive nerve terminal involvement might be undetected by standard diagnostic techniques.

journal_name

Muscle Nerve

journal_title

Muscle & nerve

authors

Galosi E,Di Pietro G,La Cesa S,Di Stefano G,Leone C,Fasolino A,Di Lionardo A,Leonetti F,Buzzetti R,Mollica C,Cruccu G,Truini A

doi

10.1002/mus.27080

subject

Has Abstract

pub_date

2021-01-01 00:00:00

pages

68-74

issue

1

eissn

0148-639X

issn

1097-4598

journal_volume

63

pub_type

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