title: Measurement of small fibre pain threshold values for the early detection of diabetic polyneuropathy.
abstract: OBJECTIVE
  To investigate whether Aδ and C fibre pain threshold values, measured using intra-epidermal electrical stimulation (IES), in people with and without Type 2 diabetes are useful in evaluating diabetic polyneuropathy (DPN) severity.
  
  
  METHODS
  Aδ and C fibre pain threshold values were measured in Japanese people with (n = 120) and without (n = 76) Type 2 diabetes by IES. Nerve conduction studies and other tests were performed to evaluate diabetic complications.
  
  
  RESULTS
  Aδ and C fibre pain threshold values were high in people with diabetes compared with control subjects (Aδ fibre: 0.050 vs. 0.030 mA, P < 0.01; C fibre: 0.180 vs. 0.070 mA, P < 0.01). Participants with diabetes and neuropathy had significantly higher Aδ and C fibre pain threshold values than participants without neuropathy (Aδ fibres 0.063 vs. 0.039 mA, P < 0.01; C fibres 0.202 vs. 0.098 mA, P < 0.05). C fibre pain threshold values were significantly higher in participants with diabetes and diabetic microvascular complications than in participants without complications. Threshold values increased with complication progression. When DPN was diagnosed according to the Diabetic Neuropathy Study Group in Japan criteria, the cut-off for the C fibre pain threshold values was 0.125 mA (area under the curve 0.758, sensitivity 81.5%, specificity 61.5%). The IES test took less time (P < 0.01) and was less invasive (P < 0.01) than the nerve conduction studies.
  
  
  CONCLUSIONS
  Intra-epidermal electrical stimulation is a non-invasive and easy measurement of small fibre pain threshold values. It may be clinically useful for C fibre measurement to diagnose early DPN as defined by the Diabetic Neuropathy Study Group in Japan criteria.
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: D
authors.initials: D
authors.lastname: Kukidome
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.|Department of Molecular Diabetology, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: T
authors.initials: T
authors.lastname: Nishikawa
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Sato
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: M
authors.initials: M
authors.lastname: Igata
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: J
authors.initials: J
authors.lastname: Kawashima
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Shimoda
authors.affiliation: Department of Community Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Matsui
authors.affiliation: Department of Morphological and Physiological Sciences, Graduate School of Health Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Obayashi
authors.affiliation: Department of Neurology, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: Y
authors.initials: Y
authors.lastname: Ando
authors.affiliation: Department of Metabolic Medicine, Faculty of Life Sciences, Kumamoto University, Kumamoto, Japan.
authors.forename: E
authors.initials: E
authors.lastname: Araki
mesh_terms: D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D003928:Diabetic Nephropathies / Q000150:complications / Q000503:physiopathology; D003929:Diabetic Neuropathies / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D003930:Diabetic Retinopathy / Q000150:complications / Q000503:physiopathology; D050171:Dyslipidemias / Q000150:complications / Q000453:epidemiology; D042241:Early Diagnosis; D004558:Electric Stimulation / Q000295:instrumentation; D004817:Epidermis; D004916:Erythromelalgia / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D036421:Nerve Fibers, Unmyelinated / Q000378:metabolism*; D017288:Pain Threshold; D000067716:Point-of-Care Testing; D011115:Polyneuropathies / Q000150:complications / Q000175:diagnosis* / Q000378:metabolism / Q000503:physiopathology; D015995:Prevalence; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index