Pj. Dyck et al., Patterns of quantitative sensation testing of hypoesthesia and hyperalgesia are predictive of diabetic polyneuropathy - A study of three cohorts, DIABET CARE, 23(4), 2000, pp. 510-517
OBJECTIVE - To test quantitative sensation testing (QST) patterns of hypoes
thesia and hyperalgesia as indicators of diabetic polyneuropathy (DPN) and
its severity.
RESEARCH DESIGN AND METHODS - We used Computer-Assisted Sensory Examination
IV; characterized the QST results of the foot of each patient in three dia
betic cohorts (similar to 1,500 patients) as hyperesthetic (less than or eq
ual to 2.5th percentile), low-normal (2.5th-50th percentiles), high-normal
(50th-97.5th percentiles),or hypoesthetic (greater than or equal to 97.5th
percentile); and tested associations with symptoms, impairments, and test a
bnormalities.
RESULTS - Overall neuropathic impairment was most severe in the pancreas-re
nal transplant and nerve growth factor cohorts, but it was much less severe
in the population-based Rochester Diabetic Neuropathy Study (RDNS) cohort.
The frequency distribution of sensory abnormalities mirrored this differen
ce. When the QST spectra of diabetic cohorts were compared with those of th
e control subject cohort for vibration and cooling sensations, the only abn
ormality observed was hypoesthesia, which was expressed as an increased num
ber of subjects with values at or above the 97.5th percentile or by an incr
eased percentage of cases with high-normal values. Symptoms and impairments
of DPN were significantly more frequent in the subjects with Values at or
above the 97.5th percentile than in the subjects whose values were between
the 50th and 97.5th percentiles. For heat pain (HP) sensation thresholds (i
ntermediate pain severity [HP:5], pain threshold [HP:0.5]. and pain-stimulu
s response slope [HP:5-0.5]), an increased frequency of both hypoalgesia an
d hyperalgesia was observed (especially in the RDNS cohort). Steeper pain-s
timulus response slopes were significantly associated with sensory symptoms
, including severity of pain.
CONCLUSIONS - 1) Decreased vibratory sensation (hypoesthesia) appears to be
characteristic of mild DPN, whereas pan-modality hypoesthesia is character
istic of severe DPN 2) A shift of vibratory and cold detection thresholds l
and also of attributes of nerve conduction and a measure of autonomic dysfu
nction) from low-normal (2.5th-50th percentiles) to high-normal (50th-37.5t
h percentiles) appears to precede overt expression of DPN and to thereby pr
ovide evidence of subclinical abnormality. 3) Heat stimulus-induced hyperes
thesia (low thresholds) occurs especially in mild DPN, and, because it corr
elates with DPN symptoms and impairments, it must be attributed to hyperalg
esia rather than to supersensitivity. Therefore, hypoalgesia or hyperalgesi
a may be an indicator of early DPN.