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1Department of Internal Medicine, Cardiovascular and Metabolic Disease Center, Inje University Sanggye Paik Hospital, Inje University College of Medicine, Seoul, Korea.
2Department of Internal Medicine, Research Institute of Clinical Medicine, Chonbuk National University Hospital, Chonbuk National University Medical School, Jeonju, Korea.
Copyright © 2016 Korean Endocrine Society
This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
CONFLICTS OF INTEREST: No potential conflict of interest relevant to this article was reported.
Classification (diameter) [8] | Function | Clinical sign and sensory testing |
---|---|---|
Myelinated Aα (13–20 μm) | Motor | Decreased ankle and knee reflexes |
Thickly myelinated Aβ (6–12 μm) | Proprioception | Impaired proprioception |
Vibration | Decreased vibration sense (128-Hz tuning fork) | |
Pressure | Hyperalgesia (cotton swab), hypoesthesia (10-g SWMF) | |
Thinly myelinated Aδ fiber (1–5 μm) | Cold | Hyperalgesia, hypoesthesia, hypoalgesia (Tip-therm, AXON GmbH) |
Sharp pain | Allodynia, hyperalgesia (cotton swab), hypoesthesia (10-g SWMF), hypoalgesia (pin-prick) | |
Unmyelinated C fibers (0.2–1.5 μm) | Warmth | Hyperalgesia, hypoesthesia, hypoalgesia (Tip-therm) |
Burning pain | Hyperalgesia (cotton swab), hypoesthesia (10-g SWMF), hypoalgesia (pin-prick) | |
Autonomic function | Decreased sweating |
Hyperalgesia, increased pain sensitivity of the skin to heat, cold, pin-prick stimuli, or blunt pressure; allodynia, pain in response to non-nociceptive stimuli; hypoesthesia, decreased sensitivity for non-painful stimuli; hypoalgesia, decreased sensitivity to painful stimuli [35].
SWMF, Semmes-Weinstein monofilament.
Scoring system | Items | Description |
---|---|---|
Michigan neuropathy screening instrument [28] | A 15-item self-administered questionnaire: pain, temperature sensation, tingling, numbness, sensory symptoms, cramps and muscle weakness, foots ulcers or cracks and amputation. | Abnormal, if ≥3 response |
Michigan diabetic neuropathy score [28] | Appearance of feet | 0, normal; 1, abnormal |
Ulceration | 0, normal; 1, abnormal | |
Ankle reflexes | 0, present; 0.5, reduced; 1, absent | |
Vibration perception | 0, present; 0.5, reduced; 1, absent | |
Abnormal, if ≥2/4 score | ||
Revised neuropathy disability score [23] | Vibration sensation (128-Hz tuning fork) | 0, present; 1, reduced/absent |
Temperature sensation | 0, present; 1, reduced/absent | |
Pin-prick | 0, present; 1, reduced/absent | |
Ankle reflex | 0, normal; 1, reduced; 2, absent | |
Abnormal, if ≥6/10 points |