The findings of a study published as a letter in Diabetes Care reveal that myofascial pain is common among patients with painful diabetic neuropathy (pDN).
Investigators from the Johannes Gutenberg-University Mainz in Germany recruited patients with pDN (n=41) and nonpainful diabetic neuropathy (npDN; n=28). Patients underwent a complete assessment, and trends in pain were evaluated.
The mean age of the study population was 66±1.3 years, and all study participants had type 2 diabetes.
The cohort of study participants with pDN demonstrated a significantly lower pain threshold (P <.01) and heat pain threshold (P <.01) compared with participants in the npDN cohort.
Myofascial pain, defined by active muscle trigger points that cause pain on direct palpation, was observed among 22% of participants in the pDN group. No study participants in the npDN group experienced myofascial pain. Most study participants with myofascial pain reported bilateral involvement, and involvement of mirror-image muscles was common.
Among the subset of patients with myofascial pain, average pain scores were significantly higher at the beginning of the cold pressor test, and a significant group-by-time interaction was reported (F[34,1054], 1.95; P =.001).
Patients with myofascial pain were also found to have higher anxiety scores compared with study participants in the npDN and nonmyofascial pDN cohorts (both P <.01), higher depression scores compared with participants in the npDN (P <.01) and nonmyofascial pDN (P <.05) cohorts, and higher impairment scores compared with participants in the npDN (P <.001) and nonmyofascial pDN (P <.05) cohorts. Participants in the nonmyofascial pDN group had higher impairment scores compared with those in the npDN group (P <.01).
This study was limited by its small sample size.
These data indicate that myofascial pain is common among patients with pDN. A previous study assessing chemotherapy-induced neuropathy found a similar rate of myofascial pain (25%), which could suggest that pain from muscle trigger points may be common in painful neuropathies in general. The authors concluded, “We recommend routine screening for myofascial pain in pDN not only for individual treatment but also for stratification in future treatment trials with pain as the primary outcome.”
Escolano-Lozano F, Buehling-Schindowski F, Krämer HH, Birklein F, Geber C. Painful diabetic neuropathy: myofascial pain makes the difference. Diabetes Care. 2022;45(10):e139-e140. doi:10.2337/dc22-1023