Diabetes Research Unit, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Glossop Road, Sheffield, S10 2JF, UK.
Department of Oncology and Human Metabolism, University of Sheffield, Sheffield, UK.
Curr Diab Rep. 2019 May 7;19(6):32. doi: 10.1007/s11892-019-1150-5.
The prevalence of diabetes mellitus and its chronic complications are increasing to epidemic proportions. This will unfortunately result in massive increases in diabetic distal symmetrical polyneuropathy (DPN) and its troublesome sequelae, including disabling neuropathic pain (painful-DPN), which affects around 25% of patients with diabetes. Why these patients develop neuropathic pain, while others with a similar degree of neuropathy do not, is not clearly understood. This review will look at recent advances that may shed some light on the differences between painful and painless-DPN.
Gender, clinical pain phenotyping, serum biomarkers, brain imaging, genetics, and skin biopsy findings have been reported to differentiate painful- from painless-DPN. Painful-DPN seems to be associated with female gender and small fiber dysfunction. Moreover, recent brain imaging studies have found neuropathic pain signatures within the central nervous system; however, whether this is the cause or effect of the pain is yet to be determined. Further research is urgently required to develop our understanding of the pathogenesis of pain in DPN in order to develop new and effective mechanistic treatments for painful-DPN.
糖尿病及其慢性并发症的患病率正呈流行趋势。不幸的是，这将导致糖尿病远端对称性多发性神经病（DPN）及其棘手的后遗症（包括致残性神经痛，疼痛性-DPN）大量增加，约 25%的糖尿病患者会出现这种情况。为什么这些患者会出现神经痛，而其他具有相似程度神经病变的患者却没有，目前还不清楚。这篇综述将探讨最近的进展，这些进展可能有助于阐明疼痛性-DPN 和无痛性-DPN 之间的差异。
性别、临床疼痛表型、血清生物标志物、脑影像学、遗传学和皮肤活检结果已被报道可区分疼痛性-DPN 和无痛性-DPN。疼痛性-DPN 似乎与女性性别和小纤维功能障碍有关。此外，最近的脑影像学研究在中枢神经系统中发现了神经病理性疼痛特征；然而，这种情况是疼痛的原因还是结果尚待确定。为了开发针对疼痛性-DPN 的新的、有效的机制治疗方法，迫切需要进一步研究以加深我们对 DPN 中疼痛发病机制的理解。
