Nervous system disease diabetic neuropathy

Association of Pain, neuropathic pain is defined as pain initiated or caused by a primary lesion, dysfunction in the nervous system". Neuropathy can be divided broadly into peripheral and central neuropathic pain, depending on whether the primary lesion or dysfunction is situated in the peripheral or central nervous system. In the periphery, neuropathic pain can result from disease or inflammatory states that affect peripheral nerves (e.g. diabetes mellitus, herpes zoster, HIV) or alternatively due to neuroma formation (amputation, nerve transection), nerve compression (e.g. tumours, entrapment) or other injuries (e.g. nerve crush, trauma). Central pain syndromes, on the other hand, result from alterations in different regions of the brain or the spinal cord. Examples include tumour or trauma affecting particular CNS structures (e.g. brainstem and thalamus) or spinal cord injury. Both the symptoms and origins of neuropathic pain are extremely diverse. Due to this variability, neuropathic pain syndromes are often difficult to treat. Some of the clinical symptoms associated with this condition include spontaneous pain, tactile allodynia (touch-evoked pain), hyperalgesia (enhanced responses to a painful stimulus) and sensory deficits. 

In diabetic patients, the incidence of clinically manifested deficits in peripheral nervous system function increases with duration of disease and is approx 50% after 25 yr of disease. The resulting diabetic neuropathies comprise a group of distinct disorders that can affect both somatic and autonomic nerves, the most common of which is symmetric sensory polyneuropathy. Clinical signs of overt human diabetic neuropathy include decreases in nerve conduction velocity and action potential amplitude and in resistance to ischemic conduction failure. These abnormalities may be accompanied by sensory deficits and, in some cases, severe pain. In diabetes of long standing, morphological deterioration is evident, and both nerve fiber loss and segmental demyelination may occur. 

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