Trigeminal pain and quantitative sensory testing in painful peripheral diabetic neuropathy.
OBJECTIVE
To evaluate patients with Diabetes Mellitus type 2 and painful peripheral neuropathy in order to investigate oral complaints and facial somatosensory findings.


METHODS
Case-control study; 29 patients (12 women, mean age 57.86 yo) with Diabetes Mellitus type 2 and 31 age-gender-matched controls were evaluated with a standardized protocol for general characteristics, orofacial pain, research diagnostic criteria for temporomandibular disorders, visual analogue scale and McGill Pain questionnaire, and a systematic protocol of quantitative sensory testing for bilateral facial sensitivity at the areas innervated by the trigeminal branches, which included the thermal detection by ThermoSensi 2, tactile evaluation with vonFrey filaments, and superficial pain thresholds with a superficial algometer (Micromar). Statistical analysis was performed with Wilcoxon, chi-square, confidence intervals and Spearman (p<0.05).


RESULTS
Orofacial pain was reported by 55.2% of patients, and the most common descriptor was fatigue (50%); 17.2% had burning mouth. Myofascial temporomandibular disorders were diagnosed in 9 (31%) patients. The study group showed higher sensory thresholds of pain at the right maxillary branch (p=0.017) but sensorial differences were not associated with pain (p=0.608). Glycemia and HbA(1c) were positively correlated with the quantitative sensory testing results of pain (p<0.05) and cold (p=0.044) perceptions. Higher pain thresholds were correlated with higher glycemia and glycated hemoglobin (p=0.027 and p=0.026).


CONCLUSIONS
There was a high prevalence of orofacial pain and burning mouth was the most common complaint. The association of loss of pain sensation and higher glycemia and glycated hemoglobin can be of clinical use for the follow-up of DM complications.
Arap
Astrid
A
Neurology Department of Medical School, Universidade de São Paulo, Brazil.
Siqueira
Silvia R D T
SR
Silva
Claudomiro B
CB
Teixeira
Manoel J
MJ
Siqueira
José T T
JT
D000328:Adult; D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D002054:Burning Mouth Syndrome / Q000175:diagnosis; D016022:Case-Control Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D003929:Diabetic Neuropathies / Q000150:complications*; D005145:Face / Q000294:innervation; D005157:Facial Pain / Q000175:diagnosis; D005221:Fatigue / Q000175:diagnosis; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008297:Male; D008442:Maxillary Nerve / Q000503:physiopathology; D008875:Middle Aged; D010147:Pain Measurement; D017288:Pain Threshold / Q000502:physiology; D012684:Sensory Thresholds / Q000502:physiology; D020886:Somatosensory Disorders / Q000175:diagnosis; D013705:Temporomandibular Joint Disorders / Q000175:diagnosis; D013697:Thermosensing / Q000502:physiology; D014110:Touch / Q000502:physiology; D014277:Trigeminal Neuralgia / Q000175:diagnosis* / Q000209:etiology
D001786:Blood Glucose; D006442:Glycated Hemoglobin