Endocrinology, Department of Systems Medicine, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy.
Curr Diab Rep. 2013 Aug;13(4):533-49. doi: 10.1007/s11892-013-0387-7.
Painful diabetic polyneuropathy (PDPN) is generally considered a variant of diabetic polyneuropathy (DPN) but the identification of distinctive aspects that characterize painful compared with painless DPN has however been addressed in many studies, mainly with the purpose of better understanding the mechanisms of neuropathic pain in the scenario of peripheral nerve damage of DPN, of determining risk markers for pain development, and also of recognizing who might respond to treatments. This review is aimed at examining available literature dealing with the issue of similarities and differences between painful and painless DPN in an attempt to respond to the question of whether painful and painless DPN are the same disease or not and to address the conundrum of why some people develop the insensate variety of DPN whilst others experience distressing pain. Thus, from the perspective of comparing painful with painless forms of DPN, this review considers the clinical correlates of PDPN, its distinctive framework of symptoms, signs, and nerve functional and structural abnormalities, the question of large and small fiber involvement, the peripheral pain mechanisms, the central processing of pain and some new insights into the pathogenesis of pain in peripheral polyneuropathies and PDPN.
痛性糖尿病多发性神经病（PDPN）通常被认为是糖尿病多发性神经病（DPN）的一种变异，但在许多研究中已经解决了将疼痛与无痛 DPN 区分开来的独特方面的问题，主要目的是更好地了解 DPN 周围神经损伤情况下神经性疼痛的机制，确定疼痛发展的风险标志物，以及识别哪些人可能对治疗有反应。本综述旨在检查处理痛性和无痛性 DPN 之间异同的现有文献，试图回答痛性和无痛性 DPN 是否为同一疾病的问题，并解决为什么有些人会出现无症状的 DPN 而另一些人会出现痛苦的疼痛这一难题。因此，从比较痛性和无痛性 DPN 的角度来看，本综述考虑了 PDPN 的临床相关性、其独特的症状、体征和神经功能及结构异常框架、大纤维和小纤维受累的问题、外周疼痛机制、疼痛的中枢处理以及对周围性多发性神经病和 PDPN 疼痛发病机制的一些新见解。
