sensation/pain syn

• Neuropathic pain


  Damage to nervous system, hyperglycemia (DM), HTN, obesity, low HDL, high triglycerides, smoke, alcoholic, age
• Neuropathic pain diagnosis


  1. T1DM: 5yr post dx, annual screen after initial

  2. T2DM: all pts at dx

  3. Small nerve function test (monofilament perception of distal big toe)

  4. Large nerve fiber function tests (vibrotory sensation with tuning fork, deep tendon reflexes at ankle compared to knee or other locations)
• Neuropathic pain diagnosis without DM

  1. Fasting serum glucose level, glucose tolerance test

  2. If unclear cause, complete history/exam, CBC, CMP, serum B12, protein immunoelectrophoresis
• Guillain Barre Syndrome


  • Preceded by infection, needs quick care, acute paralytic polyneuropathy impacts peripheral nervous system/acute immune-mediated polyneuropathy (acute inflammatory polyradiculoneuropathy AIDP)
  • Progressive/symmetric muscle weakness, absent/weak deep tendon reflexes, presents within a few days with LE weakness->arms, trunk, muscles of respiration and cranial nerves, sensory changes with paresthesias/nerve pain, numbness
  • 4wk illness, inpatient treatment
  • Elders/rapid onset/severe weakness/respiratory support need all indicate more intensive care
  • Diagnosis: lumbar puncture (elevated CSF protein/normal WBC), EMG studies, CBC/CMP/ESR to rule out other causes
• Diabetic peripheral neuropathy


  • Distal systemic polyneuropathy, autonomic neuropathy, polyradiculopathies
  • Pain to distal extremities, paresthesia to distal extremities, extreme sensitivity to touch, progressive loss of sensation, loss of balance, distal motor symptoms
• Chronic Regional Pain Syndrome

  • Painful distal extremity, post injury, symptoms last longer than expected, allodynia, hyperalgesia, motor impairment of strength, limited movement, skin color/temperature changes, hair distribution/nail changes, pain disproportionate to injury
  • Diagnosis: xray, EMG, MRI to rule out other causes