Elsevier

Journal of Diabetes and its Complications

Volume 20, Issue 5, September–October 2006, Pages 308-316
Journal of Diabetes and its Complications

Original article
Measuring the pain threshold and tolerance using electrical stimulation in patients with Type II diabetes mellitus

https://doi.org/10.1016/j.jdiacomp.2005.07.004Get rights and content

Abstract

Objective

The aim of the study was to assess pain threshold and tolerance in diabetics with/without neuropathy and to compare that in with healthy controls.

Methods

In this cross-sectional and comparative study, 79 diabetics (57 without neuropathy and 22 with neuropathy) and 32 healthy controls (63 women and 48 men) with a mean age of 48.11±7.52 years were studied. Seventy-nine diabetics, aged 33 to 74, who met inclusion criteria were evaluated using electrical stimulation (faradic current) to assess pain threshold and tolerance on upper and lower extremities and were compared with healthy controls. They also were evaluated using Michigan Neuropathy Screening Index (MNSI), 5.07 mmg Semmes Weinstein Monofilament, and visual analog scale (VAS). Pain threshold and tolerance were measured experimentally.

Results

Of all participants, 32.4% had pain complain. Eighteen diabetics without neuropathy (31.6%) and 9 diabetics with neuropathy (40.9%) reported pain. The result of upper and lower extremities' pain threshold and tolerance showed that there was a significant difference between diabetics and healthy participants (P<.05). Diabetics with neuropathy had the highest pain threshold and tolerance. The impairments in light touch sense were highest in diabetics with neuropathy (P<.05).

Conclusion

Measuring pain threshold and tolerance of diabetic patients using electrical stimulation is an easy, noninvasive, cheap and repeatable method and can be used for defining the onset of diabetic neuropathy and controlling prognosis at early stage.

Introduction

Diabetes mellitus (DM) is characterized by impairments in carbohydrates, fat, protein metabolisms, and vessels as a result of insulin insufficiency or insulin absence. Disease with very severe complications cause higher mortality (Ellen, 1994, Kahn & Weir, 1994, WHO, 1985, Yaltkaya et al., 1996).

The occurrence of complications is a corner point in diabetics' life (Skenazy & Bigler, 1995). Having complications cause diabetics to consider themselves as diabetics. Diabetic neuropathy is the most common and troublesome complication of DM leading to great morbidity and mortality besides the huge economic burden for diabetes care. The progression of neuropathy can be reduced by early detection and intervention (Viswarothen et al., 2004). Polineuropathical pain is common among elderly patients. The more the pain increases, the chronic depression alleviates and vice versa. Inactivity, muscle atrophy, impairments in social life addiction to analgesics results with increase in depression and pain. Fear, sleep disorders, and mood changes are observed in patients secondary to pain (Ellen, 1994, King, 1998, Kvinesdal et al., 1984, Yaltkaya et al., 1996). Even after controlling for general health status and depressive symptoms, chronic pain is a major factor in the performance of self-care behaviors that are important for minimizing diabetes-related complications. Competing demands, such as chronic pain, should be considered dealing with patients to develop effective self-care regimen (Krein, Heisler, & Maki, 2005). That is why pain assessment should be included into the evaluation methods of polineuropathies.

The intensity of pain in diabetic neuropathy seems to depend on small nerve fiber damage and differentiation according to Kramer et al. Quantitative sensory threshold test, including pain threshold and tolerance, is an important noninvasive tool for the investigation of various disorders such as DM, peripheric nerve lesion, and so forth, and is widely used in clinical trials. A number of different devices are used in physical therapy and rehabilitation settings and in research studies, but the manner in which results from these devices relate to each other for a given modality is frequently speculative (Krämer, Rolke & Bicke, 2004).

The aims of this study were to assess pain threshold and tolerance in diabetics and compare them with healthy controls. The study was also carried out for defining the electrodiagnostic value of pain analysis at early stage of neuropathy.

Section snippets

Material and method

This comparative study was carried out at Division of Turkish Diabetes Association at Denizli (DTDAD) and Pamukkale University School of Physical Therapy and Rehabilitation between September 2003 and April 2004. The study was supported and approved by authorized staff who work in DTDAD and by the Committee on Research of Pamukkale University, School of Physical Therapy, and Rehabilitation in Denizli. The verbal informed consent was obtained in all participants.

All measures were performed by a

Results

Seventy-nine Type II diabetic and 32 healthy controls, for a total of 111 participants, were included in our study. The first group consisted of 57 diabetics without PNP, Group II consisted of 22 diabetics with PNP, and Group III had 32 healthy controls.

The physical characteristics of the participants were compared by one-way ANOVA test; there was no difference between the mean age and height of the participants (P>.05). However, the differences in the BMI score and body weight among groups

Discussion

The purpose of this study was to examine pain threshold and tolerance of diabetic patients, compare the results with healthy controls, and define the electrodiagnostic value of pain analysis in PNP diagnosis at early stages of DM. It was thought that the electrical stimulation, which is usually used in the treatment of many diseases by physical therapists, could be used as an assessment method at early stage of DM so the precautions could be taken before diabetic complications occur.

Fifty-seven

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