A pain in the skin. Regenerating nerve sprouts are distinctly associated with ongoing burning pain in patients with diabetes
| Autor: | Páll Karlsson, Caterina Leone, Giorgio Cruccu, Andrea Truini, G. Di Stefano, S. La Cesa, Eleonora Galosi, Antonella Biasiotta, Alessandra Fasolino |
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| Rok vydání: | 2018 |
| Předmět: |
0301 basic medicine
Adult Male medicine.medical_specialty peripheral neuropathy neuropathic pain diabetes Biopsy Gastroenterology Sensitivity and Specificity 03 medical and health sciences 0302 clinical medicine GAP-43 Protein Nerve Fibers Diabetic Neuropathies Diabetes mellitus Internal medicine medicine Humans Prospective Studies Prospective cohort study Burning Pain Aged Skin Aged 80 and over medicine.diagnostic_test business.industry Middle Aged medicine.disease Nerve Regeneration 030104 developmental biology Anesthesiology and Pain Medicine Hyperalgesia Skin biopsy Neuropathic pain Neuralgia Female medicine.symptom business Ubiquitin Thiolesterase 030217 neurology & neurosurgery |
| Zdroj: | Galosi, E, La Cesa, S, Di Stefano, G, Karlsson, P, Fasolino, A, Leone, C, Biasiotta, A, Cruccu, G & Truini, A 2018, ' A pain in the skin. Regenerating nerve sprouts are distinctly associated with ongoing burning pain in patients with diabetes ', European Journal of Pain (United Kingdom), vol. 22, no. 10, pp. 1727-1734 . https://doi.org/10.1002/ejp.1259 |
| ISSN: | 1532-2149 |
| DOI: | 10.1002/ejp.1259 |
| Popis: | Backgrounds: Patients with diabetic polyneuropathy commonly suffer from ongoing burning pain and dynamic mechanical allodynia. In this clinical and skin biopsy study, we aimed at assessing how intraepidermal regenerating nerve sprouts are associated with these two types of pain. Methods: We consecutively enrolled 85 patients with diabetic polyneuropathy. All patients underwent skin biopsy at the distal leg. Intraepidermal nerve fibres were immunostained with the anti-protein gene product 9.5 (PGP9.5) to quantify all intraepidermal nerve fibres, and the growth-associated protein 43 (GAP43) to quantify regenerating nerve sprouts. Results: We found that the GAP43-stained intraepidermal nerve fibre density and the ratio GAP43/PGP9.5 were significantly higher in patients with ongoing burning pain than in those without. The area of receiver operating characteristic (ROC) curve for the ratio GAP43/PGP9.5 was 0.74 and yielded a sensitivity and specificity for identifying ongoing burning pain of 72% and 71%, respectively. Conversely, although the density of PGP9.5 and GAP43 intraepidermal nerve fibre was higher in patients with dynamic mechanical allodynia than in those without, this difference was statistically weak and the ROC curve analysis of skin biopsy variables for this type of pain failed to reach the statistical significance. Conclusion: Our clinical and skin biopsy study showed that ongoing burning pain was strongly associated with regenerating sprouts, as assessed with GAP43 immunostaining. This finding improves our understanding on the mechanisms underlying neuropathic pain in patients with diabetic polyneuropathy and suggests that the GAP43/PGP 9.5 ratio might be used as an objective marker for ongoing burning pain due to regenerating sprouts. Significance: Our skin biopsy study showing that regenerating sprouts, as assessed with GAP43-staining, were strongly associated with ongoing burning pain, improves our knowledge on the mechanisms underlying neuropathic pain in patients with diabetes. |
| Databáze: | OpenAIRE |
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