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Painful and Painless Diabetic Neuropathy: One Disease or Two?

  • Microvascular Complications-Neuropathy (D Ziegler, Section Editor)
  • Published:
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Abstract

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.

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Acknowledgment

Carla Greco is a trainee of the Specialization School for Nutritional Sciences of Tor Vergata University, Rome, Italy.

Conflict of Interest

Vincenza Spallone has board membership with Wörwag Pharma, TRIGOcare International, Daichii Sankyo Europe, and Ely Lilly Italy. She also has been a consultant for AWP srl, Wörwag Pharma Group. She has received grant support from Biocure SrL. She has received payment for development of educational presentations including service on speakers’ bureaus for continuing medical education from Ely Lilly Italy, Sanofi Aventis, and Pfizer Italy.

Carla Greco declares that she has no conflict of interest.

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  1. Endocrinology, Department of Systems Medicine, University of Tor Vergata, Via Montpellier 1, 00133, Rome, Italy

    Vincenza Spallone & Carla Greco

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  1. Vincenza Spallone
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Correspondence to Vincenza Spallone.

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Spallone, V., Greco, C. Painful and Painless Diabetic Neuropathy: One Disease or Two?. Curr Diab Rep 13, 533–549 (2013). https://doi.org/10.1007/s11892-013-0387-7

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