Painful diabetic neuropathy is common and can be extremely disabling to affected patients. With the prevalence of type 2 diabetes set to increase by epidemic proportions in the next 2 decades, totalling around half a billion worldwide by 2030, the clinical and economic impact of painful diabetic neuropathy will be considerable. Unfortunately, current treatments are not only primarily symptomatic but are also frequently ineffective. This is the result of our poor understanding of the mechanisms of neuropathic pain in diabetes.
Giuseppe Lauria tackles this difficult area by critically examining recent literature on pathophysiological mechanisms that may be involved in painful diabetic neuropathy. This is a breath of fresh air as most recent reviews in the area tend to focus on current symptomatic pharmacological treatments for painful diabetic neuropathy. This excellent, “must read” review discusses recent advances in the role of the immune system and activated microglia and astrocytes that can release various compounds, including growth factors and chemokines, that may influence neuronal activity, in addition to established mechanisms such as central and peripheral sensitization and descending inhibition.
Neuropathic pain appears to have a qualitative change or a “life of its own” with chronicity, and this article attempts to identify the various mechanisms that may be responsible for this maintenance of pain over time, including genetic factors that may hold the ultimate defining mechanisms. Identification and, hence, the targeting of these potential key mechanisms are likely to lead to the development of novel compounds that are not only more efficacious for treating this debilitating disease, but may also result in less drug side effects that many current compounds have. This article goes a long way in stimulating recent innovative concepts regarding pain mechanisms in diabetes and is therefore of interest not only to endocrinologists/pain specialists/neurologists, but also to general physicians.