Spinal disinhibition: evidence for a hyperpathia phenotype in painful diabetic neuropathy

Marshall, A., Kalteniece, A., Ferdousi, M., Azmi, S., Jude, E., Adamson, C., D'Onofrio, L., Dhage, S., Soran, H., Campbell, J., Lee-Kubli, C., Hamdy, S., Malik, R. A., Calcutt, N. A. and Marshall, A. (2023) Spinal disinhibition: evidence for a hyperpathia phenotype in painful diabetic neuropathy. Brain Communications. 5(2) 2632-1297.

Marshall_et_al_OUP_2013_Spinal_disinhibition_evidence_for_a_hyperpathia_phenotype_in_painful_diabetic_neur ... (1MB)

Item Type:	Article
Abstract:	The dominant sensory phenotype in patients with diabetic polyneuropathy and neuropathic pain is a loss of function. This raises questions as to which mechanisms underlie pain generation in the face of potentially reduced afferent input. One potential mechanism is spinal disinhibition, whereby a loss of spinal inhibition leads to increased ascending nociceptive drive due to amplification of, or a failure to suppress, incoming signals from the periphery. We aimed to determine whether a putative biomarker of spinal disinhibition, impaired rate dependent depression of the Hoffmann-reflex, is associated with a mechanistically appropriate and distinct pain phenotype in patients with painful diabetic neuropathy. In this cross-sectional study, ninety-three patients with diabetic neuropathy underwent testing of H-reflex rate dependent depression and detailed clinical and sensory phenotyping, including quantitative sensory testing. Compared to neuropathic patients without pain, patients with painful diabetic neuropathy had impaired H-reflex rate dependent depression at 1, 2 and 3Hz (p=These findings support the hypothesis that spinal disinhibition is an important centrally mediated pain amplification mechanism in painful diabetic neuropathy and that abnormal H-reflex rate dependent depression is associated with a distinct phenotype, arguably akin to hyperpathia, with combined loss and relative gain of function leading to increasing nociceptive drive.
Uncontrolled Keywords:	/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Creators:	Marshall, Anne, Kalteniece, Alise, Ferdousi, Maryam, Azmi, Shazli, Jude, Edward, Adamson, Clare, D'Onofrio, Luca, Dhage, Shaishav, Soran, Handrean, Campbell, Jackie, Lee-Kubli, Corinne, Hamdy, Shaheen, Malik, Rayaz A, Calcutt, Nigel A and Marshall, Andrew
Faculties, Divisions and Institutes:	?? HSRES ??
Date:	28 February 2023
Date Type:	Publication
Journal or Publication Title:	Brain Communications
Volume:	5
Number:	2
Language:	English
DOI:	https://doi.org/10.1093/braincomms/fcad051
ISSN:	2632-1297
Status:	Published / Disseminated
Refereed:	Yes
Related URLs:	https://academic.oup.com/braincomms/arti... https://pure.northampton.ac.uk/en/public...
URI:	http://nectar.northampton.ac.uk/id/eprint/19280

Actions (login required)

Edit Item

Altmetric