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.

Differential involvement of myelinated and unmyelinated nerve fibers in painful diabetic polyneuropathy / 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.. - In: MUSCLE & NERVE. - ISSN 0148-639X. - 63:1(2021), pp. 68-74. [10.1002/mus.27080]

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

Galosi E.;Di Pietro G.;La Cesa S.;Di Stefano G.;Leone C.;Fasolino A.;Di Lionardo A.;Buzzetti R.;Mollica C.;Cruccu G.;Truini A.
2021

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.
2021
diabetes; neuropathic pain; painful neuropathy; skin biopsy; small-fiber neuropathy
01 Pubblicazione su rivista::01a Articolo in rivista
Differential involvement of myelinated and unmyelinated nerve fibers in painful diabetic polyneuropathy / 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.. - In: MUSCLE & NERVE. - ISSN 0148-639X. - 63:1(2021), pp. 68-74. [10.1002/mus.27080]
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11573/1521709
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