Pain can have different causes – Heilpraxis

Diabetes: evidence of the importance of muscle pain

More than seven million people in Germany suffer from Diabetes. Metabolic disease can lead to various secondary diseases. One of them is the painful diabetic polyneuropathy. It’s not just harmed by Annoy caused, but can also muscle can be conditional, as researchers have now found.

A research team from the University Medical Center Mainz has discovered that painful diabetic polyneuropathy is not only caused by damaged nerves, but can also be caused by muscles. Type 2 diabetic patients with both causes of pain had higher pain intensity, tolerated it less well and also had psychological disorders. The research results were published in the journal “diabetic treatments“published.

Pain can have different causes

According Message In a comprehensive clinical examination, scientists from the Department of Neurology at the University Medical Center Mainz have shown that the pain that occurs in diabetes can have various causes.

About a quarter of people with painful diabetic polyneuropathy had both nerve pain and muscle pain.

Another important finding: these patients had physical and mental impairments than those affected by exclusively nerve pain.

Diabetic polyneuropathy caused by type 2 diabetes

Under the direction of Univ.-Prof. Dr. Frank Birklein, Clinical Director and Head of the Department for Peripheral Neurology and Pain at the Clinic and Polyclinic for Neurology at the University Medical Center Mainz, the “Pain – Autonomic Nervous System” working group examined a total of 69 people with diabetic polyneuropathy caused by type 2 diabetes.

This was accompanied by pain in 41 patients. To the individual impairments In order to register the people tested, the researchers conducted a comprehensive clinical investigation in which, in addition to standardized tests, a comprehensive investigation of the sensitive phenotype and endogenous pain modulation was carried out.

In addition, questionnaires were used to assess pain self evaluation depressive symptoms, anxiety symptoms and impairments caused by polyneuropathy.

Higher pain intensity and poorer pain tolerance

The result: All 41 participants with painful diabetic polyneuropathy met the criteria for nerve (neuropathic) pain. In 22% of them, another form of pain was also found, which is caused by the muscles: the so-called myofascial pain are characterized by active muscle trigger points.

As explained in the communication, these hardenings are resolved in the muscle tissue pain when touched directly or when subjected to physical exertion. In the participants examined, painful muscle TrPs were located in the anterior or posterior calf muscles and in the small plantar muscles, and were found on both sides in 89% of those tested. In the majority of cases (78 percent), they were symmetrical.

Regarding the physical and psychological effects of diabetic polyneuropathy, patients with an additional component of myofascial pain differed significantly from those with exclusively neuropathic pain: participants with both types of pain had a higher level pain intensity and a worse pain tolerance.

In addition, they had higher levels of anxiety and depression scores and they reported greater polyneuropathy-related impairments in aspects such as sleep, social relationships, or the ability to walk.

Consider muscle mechanisms in routine screening

About half of all diabetics develop polyneuropathy. About half of those affected experience peripheral damage the nervous systemthe part of the nervous system located outside the brain and spinal cord.

In the case of polyneuropathy, the hands and feet are particularly affected by nerve damage. Common symptoms of the disease are abnormal sensations such as tingling and numbness.

Up to a third of diabetic patients with polyneuropathy also experience pain that affects many areas of life such as work, social activities or sleep. In many cases this can be done with a depressive development on.

Until now, pain in diabetic polyneuropathy has mainly been justified neuropathically. This means that damage to the nervous system is assumed to be the sole cause of the pain. The treatment and development of new therapeutic options for pain in diabetic polyneuropathy are also targeted for this. form of pain.

Other possible individual components such as causes of pain in the tissues, in the bones or in the muscles, on the other hand, has not yet been taken into account as a standard. This leads to very heterogeneous and in many cases moderate therapeutic successes.

Based on the results of the study, the researchers recommend that patients with painful diabetic polyneuropathy “A routine, both in individual treatment and in drug studies screening after myofascial pain »according to corresponding author PD Dr. Christian Geber, Associate Lecturer at the Neurology Clinic and Polyclinic of the University Medical Center Mainz and Chief Physician at the DRK Pain Center Mainz.

“By adapting the clinical examination, this would be easy to implement in practice. In this way, could be significantly improved in the future therapeutic successes be achieved”, underlines the expert. (ad)