Pathophysiology of neuropathic pain in diabetic neuropathy, also called painful diabetic neuropathy (PDN) is not well understood. Neither basic science nor clinical research provides clear insights into the pathophysiology of PDN. Pathology of the PDN has been predominantly studied at the level of the peripheral nervous system and consequently, all of PDN pathophysiological mechanisms are ascribed to the peripheral nervous system. However, it has been postulated that in addition to peripheral mechanisms, central nervous system mechanisms probably play significant role in the overall manifestations of the PDN (1). Diabetes has effects on many aspects of brain function that are probably subtle, but significant (2-7). These include effects on mood (2,4), which are known to influence modulation of pain perception (8) and as such would have effect on perception of pain in case of PDN; however, no study has investigated those

From: Contemporary Diabetes: Diabetic Neuropathy: Clinical Management, Second Edition Edited by: A. Veves and R. Malik © Humana Press Inc., Totowa, NJ

aspects of diabetes. Consequently, this chapter reviews what is known about neuropathic pain in general, with the hope that this information can provide insight into PDN.

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