PAINFUL NEUROPATHY AND FOOT ULCERATION IN DIABETIC-PATIENTS

OBJECTIVE - To examine the prevalence of painful symptoms in neuropath ic patients with or without foot ulceration. It has been suggested tha t there are two clinical presentations of sensory diabetic neuropathy with little overlap: painful (acute or chronic) and painless with recu rrent foot ulceration. RESEARCH DESIGN AND METHODS- We examined three groups of diabetic patients matched for age and duration of diabetes-2 4 without neuropathy on clinical grounds (mean age 56.1 yr [range 38-7 6 yr], diabetes duration 12.6 yr [0.4-40 yr]), 30 with neuropathy (mea n age 55.3 yr [range 21-73 yr], diabetes duration 17.3 yr [range 0.2-6 1 yr]), and 40 with neuropathic foot ulceration (mean age 58.1 yr [ran ge 41-72 yr], diabetes duration 18.5 yr [range 1-46 yr])-and compared them with 20 healthy subjects (mean age 50 yr [range 37-69 yr]). For e valuation of neuropathy, the neuropathy symptom score, neuropathy disa bility score, and vibration perception threshold were measured. RESULT S- No difference existed between the neuropathic and foot ulcer groups in the neuropathy symptom score (4.2 +/- 3.9 [mean +/- SD] vs. 2.5 +/ - 2. 1, NS) and neuropathy disability score (15.1 +/- 5.7 vs. 16.8 +/- 6.1, NS), but the vibration perception threshold was lower in the neu ropathic group (30.1 +/- 13.4 vs. 40.5 +/- 13.8 V, P < 0.001). Painful symptoms (neuropathy symptom score > 3), either in the past or during the time the study was conducted, had been experienced by none of the control subjects, 7 (29%) of the nonneuropathic group, 18 (60%) of th e neuropathic group, and 17 (43%) of the foot ulcer group (NS for the last two groups), and were present at the time of examination in 13 (4 3%) of the neuropathic group and in 13 (33%) of the foot ulcer group ( NS in all groups). Duration of symptoms was < 12 mo in 12 (40%) neurop athic and 15 (38%) foot ulcer patients (NS). CONCLUSIONS- We conclude that painful symptoms are frequent in diabetic neuropathy, irrespectiv e of the presence or absence of foot ulceration and that these symptom s can occur at any stage of the disease. These results suggest that th ere is a spectrum of neuropathic syndromes from the painful to the pat ients with foot ulceration, and that much overlap exists.