A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy.
Diabetic polyneuropathy (DPN) is a major cause of neuropathic pain and a frequent target condition in analgesic treatment trials. Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely...
| Main Authors: | , , , , , , , , , , , |
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| Format: | Journal article |
| Language: | English |
| Published: |
Lippincott, Williams & Wilkins
2016
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| _version_ | 1797101463134011392 |
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| author | Scholz, J Rathmell, J David, W Chad, D Broderick, A Perros, S Shin, N Wells, J Davis, J DiMaggio, C Wang, S Tate, S |
| author_facet | Scholz, J Rathmell, J David, W Chad, D Broderick, A Perros, S Shin, N Wells, J Davis, J DiMaggio, C Wang, S Tate, S |
| author_sort | Scholz, J |
| collection | OXFORD |
| description | Diabetic polyneuropathy (DPN) is a major cause of neuropathic pain and a frequent target condition in analgesic treatment trials. Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely to have therapeutic relevance. The aim of this study was to develop a tool for the bedside assessment of painful neuropathies such as DPN that captures the diversity of phenotypes. Sixty-one patients with type 2 diabetes (DM2) and painful neuropathy, 19 patients with painless DPN, 25 patients with DM2 but no clinical evidence of neuropathy and 20 healthy control subjects completed a structured interview (47 items) and a standardized physical examination (39 items). After analyzing critical features of pain and painless symptoms and examining the outcome of physical tests of sensory function, we determined the principal components of the phenotypic variance among patients. Increased sensitivity to mechanical or thermal stimuli and, to a lesser extent, the sensory quality of pain or paresthesia were the most discriminating elements of DPN phenotypes. Correlation patterns of symptoms and signs indicated the involvement of functionally distinct nerve fiber populations. We combined interview questions and physical tests identifying these differences in a shortened assessment protocol that we named Standardized Evaluation of Pain and Somatosensory Function (StEPS). StEPS generates a phenotypic profile of patients with neuropathy. Separate intensity ratings for spontaneous painful symptoms and pain evoked by standard stimuli support a detailed documentation of neuropathic pain and its response to analgesic treatment. |
| first_indexed | 2024-03-07T05:52:18Z |
| format | Journal article |
| id | oxford-uuid:e94f298a-4775-4a87-ad32-9fa7a40c8875 |
| institution | University of Oxford |
| language | English |
| last_indexed | 2024-03-07T05:52:18Z |
| publishDate | 2016 |
| publisher | Lippincott, Williams & Wilkins |
| record_format | dspace |
| spelling | oxford-uuid:e94f298a-4775-4a87-ad32-9fa7a40c88752022-03-27T10:53:21ZA standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy.Journal articlehttp://purl.org/coar/resource_type/c_dcae04bcuuid:e94f298a-4775-4a87-ad32-9fa7a40c8875EnglishSymplectic Elements at OxfordLippincott, Williams & Wilkins2016Scholz, JRathmell, JDavid, WChad, DBroderick, APerros, SShin, NWells, JDavis, JDiMaggio, CWang, STate, SDiabetic polyneuropathy (DPN) is a major cause of neuropathic pain and a frequent target condition in analgesic treatment trials. Differences in the clinical symptoms and signs associated with DPN suggest distinct pathophysiological mechanisms underlying nerve damage and dysfunction that are likely to have therapeutic relevance. The aim of this study was to develop a tool for the bedside assessment of painful neuropathies such as DPN that captures the diversity of phenotypes. Sixty-one patients with type 2 diabetes (DM2) and painful neuropathy, 19 patients with painless DPN, 25 patients with DM2 but no clinical evidence of neuropathy and 20 healthy control subjects completed a structured interview (47 items) and a standardized physical examination (39 items). After analyzing critical features of pain and painless symptoms and examining the outcome of physical tests of sensory function, we determined the principal components of the phenotypic variance among patients. Increased sensitivity to mechanical or thermal stimuli and, to a lesser extent, the sensory quality of pain or paresthesia were the most discriminating elements of DPN phenotypes. Correlation patterns of symptoms and signs indicated the involvement of functionally distinct nerve fiber populations. We combined interview questions and physical tests identifying these differences in a shortened assessment protocol that we named Standardized Evaluation of Pain and Somatosensory Function (StEPS). StEPS generates a phenotypic profile of patients with neuropathy. Separate intensity ratings for spontaneous painful symptoms and pain evoked by standard stimuli support a detailed documentation of neuropathic pain and its response to analgesic treatment. |
| spellingShingle | Scholz, J Rathmell, J David, W Chad, D Broderick, A Perros, S Shin, N Wells, J Davis, J DiMaggio, C Wang, S Tate, S A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy. |
| title | A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy. |
| title_full | A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy. |
| title_fullStr | A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy. |
| title_full_unstemmed | A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy. |
| title_short | A standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy. |
| title_sort | standardized clinical evaluation of phenotypic diversity in diabetic polyneuropathy |
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