Patients with type 1 diabetes (T1D) may be more hypoalgesic to bone pressure pain detection thresholds (pPDT) and pressure pain tolerance thresholds (pPTT), regardless of lower vibration detection thresholds (VDT), according to results of a study recently published in Frontiers in Pain Research.
This cross-sectional study included 122 healthy patients and 155 with diabetes. Of patients with diabetes, 56 had T1D and 99 had type 2 diabetes (TD2). Patients with T1D and T2D were assessed and compared against each other for VDT (normal, <18 V; intermediary, 18-25 V; high, >25 V), pPDT, pPTT, tonic cold pain via hand immersion in ice water, and central pain mechanisms, including conditioned pain modulation and temporal summation. Comparison between groups was performed using a linear regression or nonparametric linear regression model.
Compared with healthy patients, and with adjustments for body mass index, age, and sex, those with diabetes had increased pPDT at L4 tibia (kilopascals [kPa], 98; 95% CI, 76-126 vs kPa, 72; 95% CI, 56-96, respectively; P =.01), increased tonic cold pain hyperalgesia (kPa, 103; 95% CI, 92-112 vs kPa, 92; 95% CI, 69-110, respectively; P <.01), and decreased temporal summation in the arm (kPa, 0; 95% CI, 0-0 vs kPa, 1; 95% CI, 0-2, respectively; P <.01) and abdomen (kPa, 0; 95% CI, 0-0 vs kPa, 1; 95% CI, 0-2, respectively; P <.01). Patients with T1D were hyperalgesic to tibial pPDT (P <.01) and pPTT (P <.01), and also had decreased VDTs (7 V; P =.02) compared with those with T2D. No association was observed between VDT and quantitative sensory testing.
Limitations to this study include the use of different sites for research, as well as potential selection bias.
The researchers concluded that there is a “co-existence of hypoesthesia to phasic bone pressure and hyperalgesia to tonic cold pain [among those with diabetes] when compared [with] healthy [patients], even after adjustments.” Additionally, “the protocol revealed differences in responses to bone pain between [patients with] T1D [vs those with] T2D,” which may be of interest in future research.
Hansen LEM, Fjelsted CA, Olesen SS, et al. Simple quantitative sensory testing reveals paradoxical co-existence of hypoesthesia and hyperalgesia in diabetes. Published online June 28, 2021. Front Pain Res. doi: 10.3389/fpain.2021.701172