Tip 2 Diabetes Mellitusta Anksiyete ve Depresyon: Sinir İletim Çalışması ve Nöropatik Ağrıyı İçeren Bir Çalışma

Abstract

Amaç: Nöropati, nöropatik ağrı ve psikiyatrik bozuklukların diabetes mellitus (DM) ile ilişkili olduğu bilinmektedir. Sinir iletim çalışması bulguları ile nöropatik ağrı, depresyon ve anksiyete arasında bir ilişki olup olmadığının ortaya çıkarılması amaçlandı. Gereç ve Yöntemler: Bu çalışmaya Eylül 2021 ile Ocak 2022 tarihleri arasında klinik nörofizyoloji laboratuvarımıza başvuran Tip 2 DM hastaları dahil edildi. Hastalara median, ulnar, sural, peroneal ve posterior tibial sinir iletim çalışmaları yapıldı. Hastalara nöropatik ağrıyı değerlendirmek için 4 Soru nöropatik ağrı anketi (DN4) uygulandı. Hastalara Hastane Anksiyete ve Depresyon Ölçeği (HADS) uygulandı. HADS'ın iki alt bölümü olan anksiyete (HADS-A) ve depresyon (HADS-D) puanları analizlere dahil edildi. Bulgular: Çalışmaya 40 DM hastası (27 erkek, 13 kadın) dahil edildi. Hastaların yaş ortalaması 57.9±12.7 (min-maks 23-83) yıl idi. Nöropatik ağrısı olan, nörofizyolojik bulgulara göre polinöropatisi olan, HADS-A ve HADS-D skorları anormal olan hasta sayısı sırasıyla 32 (%80), 23 (%58), 17 (%43) ve 24 (%60) idi. Nöropatik ağrı, polinöropatisi olan ve olmayan sırasıyla 22 (%96) ve 10 (%59) hastada mevcuttu. Depresyonu olan 22 (%92) hastada ve depresyonu olmayan 16 (%63) hastada nöropatik ağrı saptandı (p=0.046). Nöropatik ağrısı olan hastalarda median, ulnar ve sural sinirlerin bileşik sinir aksiyon potansiyeli amplitüdleri nöropatik ağrısı olmayanlara göre daha düşüktü (p=0.011, p=0.027, p<0.001). Sonuç: Bu çalışmada Tip 2 DM hastalarında nöropatik ağrı, depresyon ve anksiyetenin görülebileceği ortaya konmuştur. Ek olarak bu çalışma, duyusal sinir iletim çalışmaları ve nöropatik ağrı arasında bir ilişki olduğunu göstermiştir. Ayrıca nöropatik ağrının depresyonu olan DM hastalarda, depresyonu olmayan DM hastalarına göre daha yaygın olduğu sonucuna varıldı.

Keywords

• Anksiyete
• depresyon
• diabetes mellitus
• sinir iletim çalışması
• nöropatik ağrı

ANXIETY AND DEPRESSION IN TYPE 2 DIABETES MELLITUS: A STUDY INCLUDING NERVE CONDUCTION STUDY AND NEUROPATHIC PAIN

Abstract

Objective: It is known that neuropathy, neuropathic pain and psychiatric disorders are associated with diabetes mellitus (DM). It was aimed to find out whether there is a relationship between nerve conduction study findings, neuropathic pain, depression and anxiety. Material and Methods: Type 2 DM patients that applied to our clinical neurophysiology laboratory between September 2021 and January 2022 were included in this study. Median, ulnar, sural, peroneal and posterior tibial nerve conduction studies were performed on the patients. Douleur Neuropathique 4 Questions (DN4) was applied to the patients to evaluate neuropathic pain. Hospital Anxiety and Depression Scale (HADS) was applied to the patients. Anxiety (HADS-A) and depression (HADS-S) scores, which are the two subsections of HADS, were included in the analysis. Results: Forty DM patients (27 males, 13 females) were included in the study. The mean age of the patients was 57.9±12.7 (min-max 23-83) years. The number of patients with neuropathic pain, polyneuropathy according to neurophysiological findings, abnormal HADS-A and HADS-D scores were 32 (80%), 23 (58%), 17 (43%), and 24 (60%), respectively. Neuropathic pain was present in 22 (96%) and 10 (59%) of the patients with and without polyneuropathy, respectively. Neuropathic pain was found in 22 (92%) patients with depression and 16 (63%) patients without depression (p=0.046). Among patients with neuropathic pain, compound nerve action potential amplitudes of median, ulnar and sural nerves were lower than those without neuropathic pain (p=0.011, p=0.027, p<0.001). Conclusion: In this study, it was revealed that neuropathic pain, depression and anxiety can be seen in Type 2 DM patients. In addition, this study showed a relationship between sensory nerve conduction studies and neuropathic pain. It was also concluded that neuropathic pain was more common in DM patients with depression than in patients without depression.

Keywords

• Anxiety
• depression
• diabetes mellitus
• nerve conduction study
• neuropathic pain

References

1. Galer BS, Gianas A, Jensen MP. Painful diabetic polyneuropathy: epidemiology, pain description, and quality of life. Diabetes Res Clin Pract. 2000;47(2):123–8.
2. Gylfadottir SS, Christensen DH, Nicolaisen SK, Andersen H, Callaghan BC, Itani M, et al. Diabetic polyneuropathy and pain, prevalence, and patient characteristics: a cross-sectional questionnaire study of 5,514 patients with recently diagnosed type 2 diabetes. Pain. 2020;161(3):574-83.
3. Vinik AI, Mehrabyan A. Diabetic neuropathies. Medical Clinics. 2004;88(4):947-99.
4. Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes care. 2006;29(7):1518–22.
5. Mukherjee N, Chaturvedi SK. Depressive symptoms and disorders in type 2 diabetes mellitus. Current opinion in psychiatry. 2019;32(5):416-21.
6. Vileikyte L, Peyrot M, Gonzalez JS, Rubin RR, Garrow AP, Stickings D et al. Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study. Diabetologia. 2009;52(7):1265–73.
7. Naranjo P, Ortega-Jimenez P, Del Reguero L, Moratalla G, Failde I. Relationship between diabetic neuropathic pain and comorbidity. Their impact on pain intensity, diabetes complications and quality of life in patients with type-2 diabetes mellitus. Diabetes research and clinical practice. 2020;165:108236.
8. Geelen CC, Smeets RJEM, Schmitz S , Van den Bergh JD, Goossens MEJB, Verbunt JA. Anxiety affects disability and quality of life in patients with painful diabetic neuropathy. Journal of Pain. 2017;21(10)1632-41.

9. Medved V, Jovanovic N, Knapic VP. The comorbidity of diabetes mellitus and psychiatric disorders. Psychiatria Danubina. 2009;21(4):585-8
10. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2013;36 Suppl 1:S67-74
11. Tankisi H, Pugdahl K, Fuglsang-Frederiksen A. Electrodiagnostic Testing of Large Fiber Polyneuropathies: A Review of Existing Guidelines. Journal of clinical neurophysiology. 2020; 37(4):277-87.
12. England JD, Gronseth GS, Franklin G, Miller RG, Asbury AK et al. Distal symmetrical polyneuropathy: definition for clinical research. Muscle and nerve. 2005;31(1):113-23.
13. Walsh J, Rabey MI, Hall TM. Agreement and Correlation Between the Self-Report Leeds Assessment of Neuropathic Symptoms and Signs and Douleur Neuropathique 4 Questions Neuropathic Pain Screening Tools in Subjects With Low Back–Related Leg Pain. Journal of Manipulative and Physiological Therapeutics. 2012;35(3):196-202.
14. Aydemir Ö, Güvenir T, Küey L, Kültür S. Validity and reliability of Turkish Version of Hospital and Depression Scale. Turk Psikiyatri Derg. 1997;8(4):280-7.
15. Chen S, Andary M, Buschbacher R, Toro DD, Smith B, So Y et al. Electrodiagnostic reference values for upper and lower limb nerve conduction studies in adult populations. Muscle and Nerve. 2016;54(3):371-7.
16. Fidancı H, Öztürk İ, Köylüoğlu A.C, Yıldız M, Buturak Ş, Arlıer Z. The needle electromyography findings in the neurophysiological classification of ulnar neuropathy at the elbow. Turk J Med Sci. 2020;50(4):804-10.
17. Fidancı H, Öztürk İ, Köylüoğlu A.C, Yıldız M, Arlıer Z. Bilateral nerve conduction studies must be considered in the diagnosis of sciatic nerve injury due to intramuscular injection. Neurological Sciences and Neurophysiology. 2020;37(2):94-9.
18. Vazquez Do Campo R. Electrodiagnostic Assessment of Polyneuropathy. Neurol Clin. 2021;39(4):1015-34.
19. Devor M. Neuropathic pain and injured nerve: peripheral mechanisms. Br Med Bul. 1991:47(3):619-30.
20. Réus GZ, Dos Santos MAB, Strassi AP, Abelaira HM, Ceretta LB, Quevedo J. Pathophysiological mechanisms involved in the relationship between diabetes and major depressive disorder. Life Sci. 2017;183:78-82
21. Joseph JJ, Golden SH. Cortisol dysregulation: the bidirectional link between stress, depression, and type 2 diabetes mellitus. Ann NY Acad Sci 2017;1391(1):20–34.
22. Finnerup NB, Attal N, Haroutounian S, McNicol E, Baron R, Dworkin RH et al. Pharmacotherapy for neuropathic pain in adults: a systematic review and meta-analysis. Lancet Neurol. 2015;14(2):162–73.