Impaired insulin signaling as a potential trigger of pain in diabetes and prediabetes.

摘要

Chronic sensorimotor distal symmetric polyneuropathy (DPN) is a common neurologic complication of diabetes mellitus. Prevalence of DPN approaches 50% in people living with diabetes, and about 10% of these cases are painful neuropathy.12 Like other symptoms of DPN (loss of reflexes or somatic sensations), "positive" symptoms (pain and paresthesias) of DPN have symmetrical distribution and distal-to-proximal progression. Nocturnal intensification seems to be another general characteristic of pain in DPN.2 Otherwise, there is a great variety of individual presentations of this syndrome. Pain may be evoked or spontaneous, persistent or intermittent, and chronic, lasting for years or remitting within 1 year of onset. The persistent, spontaneous pain may be described as superficial or deep, dull, aching, cramp-like, burning, or crushing. The intermittent, chronic pain is frequently perceived as electric-like, shooting, or lancinating. Mechanical allodynia (painful perception of normally nonpainful stimuli) and hyperalgesia (exaggerated pain in response to moderately painful mechanical stimuli) are common types of evoked pain.