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Do The Right Test - THE MODALITY - Start with pinprick for small fibre deficit
“Assessment should include a careful history and temperature or pinprick sensation”
THE MODALITY
Formerly pinprick has not been considered the primary or most fashionable choice for sensory assessment in diabetic neuropathy though the 2017 publication Diabetic Neuropathy: A Position Statement by the American Diabetes Association statement now makes it’s role “critical” 1. It states: “Screening for symptoms and signs of diabetic neuropathy is also critical in clinical practice, as it may detect the earliest stages of neuropathy, enabling early intervention” and that: “Assessment should include a careful history and either temperature or pinprick sensation”. Pinprick is one of 5 medically useful devices by which to assess sensation, especially with an instrument designed to lend itself to an easy testing scenario and utilising the very straight forward technique described by key source material cited by ADA literature. As a testing modality for the prediction of serious diabetic complications pinprick has been reputably demonstrated to be rather more sensitive than current fashion would suggest 1,2,3,4,5.
1. Pop-Busui et al, Diabetic Neuropathy: A Position Statement by the American Diabetes Association 2017; Diabetes Care 2017;40:136–154
2. Standards of Medical Care in Diabetes, ADA Position Statement, January 2015, Diabetes Care, Volume 38, Supplement 1, PS62-4.
3. Boulton et al, Comprehensive Foot Examination and Risk Assessment: A report of the Task Force of the Foot Care Interest Group of the American Diabetes Association, with endorsement by the American Association of Clinical Endocrinologists, Diabetes Care August 2008 vol. 31 no. 8 1679- 1685, p1681)
4. Abbott et al, The North-West Diabetes Foot Care Study: incidence of, and risk factors for, new diabetic foot ulceration in a community-based patient cohort; 2002, Diabetes UK. Diabetic Medicine, 19, 377–384
5. Burgess et al, Early Detection of Diabetic Peripheral Neuropathy: A Focus on Small Nerve Fibres, Diagnostics 2021, 11, 165
Do The Right Test - THE MODALITY
Employ Pinprick Modality for greater SENSITIVITY Than Monofilament