The Pain in Neuropathy Study (PiNS): a cross-sectional observational study determining the somatosensory phenotype of painful and painless diabetic neuropathy
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Published version
Author(s)
Type
Journal Article
Abstract
Disabling neuropathic pain (NeuP) is a common sequel of diabetic peripheral neuropathy (DPN). We aimed to characterise the sensory phenotype of patients with and without NeuP, assess screening tools for NeuP, and relate DPN severity to NeuP. The Pain in Neuropathy Study (PiNS) is an observational cross-sectional multicentre study. A total of 191 patients with DPN underwent neurological examination, quantitative sensory testing, nerve conduction studies, and skin biopsy for intraepidermal nerve fibre density assessment. A set of questionnaires assessed the presence of pain, pain intensity, pain distribution, and the psychological and functional impact of pain. Patients were divided according to the presence of DPN, and thereafter according to the presence and severity of NeuP. The DN4 questionnaire demonstrated excellent sensitivity (88%) and specificity (93%) in screening for NeuP. There was a positive correlation between greater neuropathy severity (r = 0.39, P < 0.01), higher HbA1c (r = 0.21, P < 0.01), and the presence (and severity) of NeuP. Diabetic peripheral neuropathy sensory phenotype is characterised by hyposensitivity to applied stimuli that was more marked in the moderate/severe NeuP group than in the mild NeuP or no NeuP groups. Brush-evoked allodynia was present in only those with NeuP (15%); the paradoxical heat sensation did not discriminate between those with (40%) and without (41.3%) NeuP. The "irritable nociceptor" subgroup could only be applied to a minority of patients (6.3%) with NeuP. This study provides a firm basis to rationalise further phenotyping of painful DPN, for instance, stratification of patients with DPN for analgesic drug trials.
Date Issued
2016-05-31
Date Acceptance
2016-01-06
Citation
Pain, 2016, 157 (5), pp.1132-1145
ISSN
0304-3959
Publisher
International Association for the Study of Pain
Start Page
1132
End Page
1145
Journal / Book Title
Pain
Volume
157
Issue
5
Copyright Statement
This is an open access article distributed under the terms of the Creative Commons Attribution License 4.0 (CC BY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Sponsor
Wellcome Trust
Identifier
PII: 00006396-201605000-00019
Grant Number
RTJ7206471-1
Subjects
Science & Technology
Life Sciences & Biomedicine
Anesthesiology
Clinical Neurology
Neurosciences
Neurosciences & Neurology
Diabetes
Diabetic neuropathy
Neuropathic pain
Quantitative sensory testing
Chronic pain
NERVE-FIBER DENSITY
PERIPHERAL NEUROPATHY
DOUBLE-BLIND
VALIDATION
QUESTIONNAIRE
DYSFUNCTION
DEFINITION
PREVALENCE
SEVERITY
PROTOCOL
Aged
Cross-Sectional Studies
Diabetic Neuropathies
Electric Stimulation
Female
Humans
Male
Middle Aged
Nerve Fibers
Neural Conduction
Neuralgia
Neurologic Examination
Phenotype
Sensation
Severity of Illness Index
Skin
Surveys and Questionnaires
Nerve Fibers
Skin
Humans
Neuralgia
Diabetic Neuropathies
Neurologic Examination
Severity of Illness Index
Cross-Sectional Studies
Electric Stimulation
Sensation
Neural Conduction
Phenotype
Aged
Middle Aged
Female
Male
Surveys and Questionnaires
11 Medical and Health Sciences
17 Psychology and Cognitive Sciences
Anesthesiology
Publication Status
Published
Date Publish Online
2016-05