Nociceptive flexion reflex in small fibers neuropathy and pain assessments†
© The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com..
BACKGROUND: The nociceptive flexion reflex (NFR) is a polysynaptic and multisegmental spinal reflex that develops in response to a noxious stimulus and is characterized by the withdrawal of the affected body part. The NFR possesses two excitatory components: early RII and late RIII. Late RIII is derived from high-threshold cutaneous afferent A-delta fibers, which are prone to injury early in the course of diabetes mellitus (DM) and may lead to neuropathic pain. We investigated NFR in patients with DM with different types of polyneuropathies to analyze the role of NFR in small fiber neuropathy (SFN).
METHODS: We included 37 patients with DM and 20 healthy participants of similar age and sex. We performed the Composite Autonomic Neuropathy Scale-31, modified Toronto Neuropathy Scale, and routine nerve conduction studies. We grouped the patients into large fiber neuropathy (LFN), SFN, and no overt neurological symptom/sign groups. In all participants, NFR was recorded on anterior tibial (AT) and biceps femoris (BF) muscles after train stimuli on the sole of the foot, and NFR-RIII findings were compared.
RESULTS: We identified 11 patients with LFN, 15 with SFN, and 11 with no overt neurological symptoms or signs. The RIII response on the AT was absent in 22 (60%) patients with DM and 8 (40%) healthy participants. The RIII response on the BF was absent in 31 (73.8%) patients and 7 (35%) healthy participants (P = .001). In DM, the latency of RIII was prolonged, and the magnitude was reduced. Abnormal findings were seen in all subgroups; however, they were more prominent in patients with LFN compared to other groups.
CONCLUSIONS: The NFR-RIII was abnormal in patients with DM even before the emergence of the neuropathic symptoms. The pattern of involvement before neuropathic symptoms was possibly related to an earlier loss of A-delta fibers.
| Medienart: |
E-Artikel |
|---|
| Erscheinungsjahr: |
2023 |
|---|---|
| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:24 |
|---|---|
| Enthalten in: |
Pain medicine (Malden, Mass.) - 24(2023), 10 vom: 03. Okt., Seite 1161-1168 |
| Sprache: |
Englisch |
|---|
| Beteiligte Personen: |
Ser, Merve Hazal [VerfasserIn] |
|---|
| Links: |
|---|
| Themen: |
Diabetic polyneuropathy |
|---|
| Anmerkungen: |
Date Completed 04.10.2023 Date Revised 07.10.2023 published: Print Citation Status MEDLINE |
|---|
| doi: |
10.1093/pm/pnad077 |
|---|
| funding: |
|
|---|---|
| Förderinstitution / Projekttitel: |
|
| PPN (Katalog-ID): |
NLM357965965 |
|---|
| LEADER | 01000naa a22002652 4500 | ||
|---|---|---|---|
| 001 | NLM357965965 | ||
| 003 | DE-627 | ||
| 005 | 20231226073731.0 | ||
| 007 | cr uuu---uuuuu | ||
| 008 | 231226s2023 xx |||||o 00| ||eng c | ||
| 024 | 7 | |a 10.1093/pm/pnad077 |2 doi | |
| 028 | 5 | 2 | |a pubmed24n1193.xml |
| 035 | |a (DE-627)NLM357965965 | ||
| 035 | |a (NLM)37294833 | ||
| 040 | |a DE-627 |b ger |c DE-627 |e rakwb | ||
| 041 | |a eng | ||
| 100 | 1 | |a Ser, Merve Hazal |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Nociceptive flexion reflex in small fibers neuropathy and pain assessments† |
| 264 | 1 | |c 2023 | |
| 336 | |a Text |b txt |2 rdacontent | ||
| 337 | |a ƒaComputermedien |b c |2 rdamedia | ||
| 338 | |a ƒa Online-Ressource |b cr |2 rdacarrier | ||
| 500 | |a Date Completed 04.10.2023 | ||
| 500 | |a Date Revised 07.10.2023 | ||
| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © The Author(s) 2023. Published by Oxford University Press on behalf of the American Academy of Pain Medicine. All rights reserved. For permissions, please e-mail: journals.permissionsoup.com. | ||
| 520 | |a BACKGROUND: The nociceptive flexion reflex (NFR) is a polysynaptic and multisegmental spinal reflex that develops in response to a noxious stimulus and is characterized by the withdrawal of the affected body part. The NFR possesses two excitatory components: early RII and late RIII. Late RIII is derived from high-threshold cutaneous afferent A-delta fibers, which are prone to injury early in the course of diabetes mellitus (DM) and may lead to neuropathic pain. We investigated NFR in patients with DM with different types of polyneuropathies to analyze the role of NFR in small fiber neuropathy (SFN) | ||
| 520 | |a METHODS: We included 37 patients with DM and 20 healthy participants of similar age and sex. We performed the Composite Autonomic Neuropathy Scale-31, modified Toronto Neuropathy Scale, and routine nerve conduction studies. We grouped the patients into large fiber neuropathy (LFN), SFN, and no overt neurological symptom/sign groups. In all participants, NFR was recorded on anterior tibial (AT) and biceps femoris (BF) muscles after train stimuli on the sole of the foot, and NFR-RIII findings were compared | ||
| 520 | |a RESULTS: We identified 11 patients with LFN, 15 with SFN, and 11 with no overt neurological symptoms or signs. The RIII response on the AT was absent in 22 (60%) patients with DM and 8 (40%) healthy participants. The RIII response on the BF was absent in 31 (73.8%) patients and 7 (35%) healthy participants (P = .001). In DM, the latency of RIII was prolonged, and the magnitude was reduced. Abnormal findings were seen in all subgroups; however, they were more prominent in patients with LFN compared to other groups | ||
| 520 | |a CONCLUSIONS: The NFR-RIII was abnormal in patients with DM even before the emergence of the neuropathic symptoms. The pattern of involvement before neuropathic symptoms was possibly related to an earlier loss of A-delta fibers | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a diabetic polyneuropathy | |
| 650 | 4 | |a mToronto | |
| 650 | 4 | |a modified Toronto neuropathy score | |
| 650 | 4 | |a nociceptive flexion reflex | |
| 650 | 4 | |a small fiber neuropathy | |
| 700 | 1 | |a Yılmaz, Basak |e verfasserin |4 aut | |
| 700 | 1 | |a Sulu, Cem |e verfasserin |4 aut | |
| 700 | 1 | |a Gönen, Mustafa Sait |e verfasserin |4 aut | |
| 700 | 1 | |a Gunduz, Aysegul |e verfasserin |4 aut | |
| 773 | 0 | 8 | |i Enthalten in |t Pain medicine (Malden, Mass.) |d 2000 |g 24(2023), 10 vom: 03. Okt., Seite 1161-1168 |w (DE-627)NLM126305021 |x 1526-4637 |7 nnns |
| 773 | 1 | 8 | |g volume:24 |g year:2023 |g number:10 |g day:03 |g month:10 |g pages:1161-1168 |
| 856 | 4 | 0 | |u http://dx.doi.org/10.1093/pm/pnad077 |3 Volltext |
| 912 | |a GBV_USEFLAG_A | ||
| 912 | |a GBV_NLM | ||
| 951 | |a AR | ||
| 952 | |d 24 |j 2023 |e 10 |b 03 |c 10 |h 1161-1168 | ||