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Introduction
Neuropathic pain is an important problem because of its complex
natural history, multiple possible etiologies, and poor response to
standard physical therapy modalities. Disorders of the peripheral
nerve system (PNS) are heterogeneous and may involve motor
bers, sensory bers, small myelinated and unmyelinated bers and
autonomic nerve bers, with variable anatomical distribution (single
nerves, several different nerves, symmetrical affection of all nerves,
plexus, or root lesions). Furthermore, pathological processes may
result in either demyelination, axonal degeneration or both. In order
to reach an exact diagnosis of any neuropathy electrophysiological
studies are crucial to obtain information about these variables.1
As a consequence of ongoing spontaneous activity arising from
the periphery, Spino Thalamic Tract neurons develop increased
background activity, enlarged receptive elds and increased responses
to afferent impulses, including normally innocuous tactile stimuli. This
phenomenon is called central sensitization. Central sensitization is an
important mechanism of persistent neuropathic pain. Additionally,
hyperalgesic/allodynic responses in uninjured neural tissues may
be the result of alterations in central nervous system processing of
afferent information (i.e. central sensitization).2 It is known that
after a peripheral nerve lesion, peripheral sensitization aberrant
regeneration may occur. Neurons become unusually sensitive and
develop spontaneous pathological activity, abnormal excitability, and
heightened sensitivity to chemical, thermal and mechanical stimuli.3
The positive and negative symptoms associated with
musculoskeletal presentations of peripheral neuropathic pain are
produced by sensitized nociceptors in neural connective tissues,
hypersensitive AIGS, a sensitized pain neuromatrix, myelin changes,
and axonal degeneration (Nee & Butler, 2006). That is, some areas
of the brain associated with sensory perception, emotion, attention,
cognition and motor learning are activated during pain experience.4
Diabetic poly neuropathy is one of the most common long-term
complications of diabetes affecting 50% of all diabetic patients.
For example, subclinical diabetic peripheral neuropathy can be
detected by electrophysiological tests, which are useful to verify the
range and extent of the nerve lesion involved in the early stage of
diabetic peripheral neuropathy.5 Other ndings suggest that thalamic
neurons can act as central generators or ampliers of pain in diabetes.6
To this point and although there are multiple methods for detecting
and monitoring DPN, nerve conduction studies (NCS) are generally
considered to be the most sensitive and reproducible.7 In hereditary
neuropathy, for example, electrophysiological studies are also used
to distinguish axonal neuropathies from demyelinating neuropathies,
though overlap and ‘intermediate’ patterns have become well
recognized.8
The electrophysiological changes are not always concordant
with clinical manifestations.5 The most common clinical and
electrophysiological manifestation of diabetic neuropathy is the
sensory disturbance, which is more severe in lower limbs.5 The
information provided by electrodiagnosis has a functional character,
telling the practitioner how the nerve and muscle are functioning.
Nerve conduction studies (NCS) and qualitative sensory testing
(QST) are important part of the complete electrodiagnostic exam.
However, in pain syndromes, conventional studies may give normal
results when large bers are not involved, and the use of autonomic
measures in such conditions is particularly relevant.8
According to Vinik et al.9 the main drawback of NCS is that small
myelinated and unmyelinated nerve bers, which are affected early
in the disease course of diabetic neuropathy, do not contribute to the
sensory action potential detected by routine NCS. Electrophysiological
data must, therefore, always be evaluated in a clinical context. Evoked
potentials, on the other hand have the capability of revealing clinically
unsuspected pathology when demyelinating diseases are suggested.
Rehabilitation programs tend to be emphasized and combined
with pharmacotherapy in daily practice.10 Traditional approaches use
Transcutaneous electrical nerve stimulation (TENS) and interferential
current (IFC) to relieve stiffness, improve mobility, relieve neuropathic
pain, reduce edema, and heal resistant foot ulcers.11 Neuro dynamic,
i.e., the mobilization of the peripheral nervous system, is a physical
approach to the treatment of pain; the method relies on inuencing
pain physiology via mechanical treatment of neural tissues and the
non-neural structures surrounding the nervous system.2,13 Through
clinical reasoning the nervous system seems to be the logical place
for treatment and explanations, although previous descriptions of this
method have not claried the relevant mechanics and physiology,
Int Phys Med Rehab J. 2018;3(1):5657 56
© 2018 Domingues et al. This is an open access article distributed under the terms of the Creative Commons Attribution License,
which permits unrestricted use, distribution, and build upon your work non-commercially.
Diabetic peripheral neuropathy and neuro dynamics
Volume 3 Issue 1 - 2018
Márcio Domingues
Centre of Investigation in Social Science, Lusofona University,
Portugal
Correspondence: Márcio Domingues, Centre of Investigation
in Social Science, Lusofona University, Portugal,
Tel (+351)217515500, Fax (+351)217577006,
Email marcio.domingues@live.com.pt
Received: December 28, 2017 | Published: February 02,2018
Abstract
Diabetic peripheral neuropathy is a common, disabling, and costly complication of
diabetes mellitus. In order to reach an exact diagnosis of electrophysiological studies
and the evaluation of diabetic neuropathy it is crucial to obtain information about these
variables. The information provided by electrodiagnosis is functional and not static,
telling the practitioner how nerve and muscle are functioning. It is known that after a
peripheral nerve, peripheral sensitization aberrant regeneration may occur alongside
this the mobilization of the nervous system is an essential approach to physical
treatment of pain. Neurodynamics encompasses interactions between mechanics
and physiology of the nervous system. Alongside this, neurodynamic as a physical
innovative therapy has been seldom used and in fact may be beneficial in preserving
nerve function thus preventing the adverse effects of intraneural edema. That is, the
rationale for the use of neurodynamic diagnosis and treatment is that it is considered
capable of detecting the increased nerve structure associated with these conditions.
International Physical Medicine & Rehabilitation Journal
Mini review Open Access
Diabetic peripheral neuropathy and neuro dynamics 57
Copyright:
©2018 Domingues
Citation: Domingues M. Diabetic peripheral neuropathy and neuro dynamics. Int Phys Med Rehab J. 2018;3(1):5657. DOI: 10.15406/ipmrj.2018.03.00075
including interactions between these two components. Within this
reasoning it is important to determine and develop clinical research
to ascertain the diagnostic value of neurodynamic sequencing in
damaged neural tissue.
Conclusion
Neurodynamic may be benecial in preserving nerve function by
limiting intraneural uid accumulation, thus preventing the adverse
effects of intra neural edema.13 The rationale for using neurodynamic
in diagnosis and treatment is that they are considered capable of
detecting the increased nerve mechanosensitivity associated with
these conditions.14,15
Acknowledgements
None.
Conict of interest
This manuscript has no conict of interest with any parts.
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... Diffusion Tensor Imaging (DTI) may be used as the assessment tool in the peripheral nerve related disease and also monitor reinnervation through fractional anisotropy (FA), apparent diffusion coefficient (ADC) [15]. Hyperglycemia leads to the altered nerve biomechanics due to fluid accumulation in the nerve [16] which can be targeted through nerve mobilization (NM) in the form of the neurodynamics and the nerve massage [17][18][19] [20,21]. The purpose of current research is to explore the effect of NM on the DTI parameters in healthy individuals and in DPN patients. ...
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Nerve conduction studies (NCS) are the most objective measure of nerve function, and their use is recommended in the clinical and epidemiological evaluation of diabetic polyneuropathy (DPN). The purpose of this study was to utilize automated NCS technology to characterize nerve conduction of patients with diabetes in primary care settings. The Diabetes cohort was drawn from 28 community clinics. The Control cohort consisted of subjects without diabetes and without evidence of neuropathy. Bilateral peroneal NCS were performed with an automated NCS instrument (NC-stat, NeuroMetrix, Inc., Waltham, MA). Neuropathic symptoms were quantified using an abbreviated form of the NTSS-6 questionnaire. Risk factors for abnormal NCS were determined using multivariate regression modeling. Data were collected for 172 control subjects and 1,358 subjects with diabetes. Statistically significant differences in peroneal NCS were found. Of the Diabetes cohort, 75.1% had at least one NCS abnormality, and 53.2% had bilateral abnormalities. Of the asymptomatic patients, 45% had bilateral NCS abnormalities. By contrast, 40% of those with clinically significant symptoms lacked bilateral NCS abnormalities. Independent predictors for bilateral NCS abnormalities were age, height, weight, hemoglobin A1c (HbA1c), and duration of diabetes. Up to 16% of the variance in NCS measurements was explained by HbA1c, duration of diabetes, and several demographic variables. This study suggests that automated NCS can provide nerve conduction confirmation of DPN in primary care settings and has clinical utility. These findings have important implications for the clinical and epidemiological evaluation of DPN.