Case of the Month #5: Thoracoabdominal Neuropathic Pain

Published: 16/04/2021


Most patients with diabetic thoracoabdominal neuropathy have type 2 diabetes and it usually occurs between the age of 50-70. Patients typically complain of neuropathic pain in a dermatomal distribution that is typically worse during the night. This may be unilateral or bilateral.

Some unilateral presentations progress to bilateral involvement in a similar manner to diabetic lumbosacral radiculoplexopathy (DLSRP; diabetic amyotrophy). The pain may be mistaken for other causes of chest or abdominal pain, leading to extensive investigations and treatments for presumed other conditions.

Weakness of the truncal muscles may give the impression of a mass or herniation, but this is a pseudohernia. Most patients do not however have motor involvement. Significant weight loss may be a feature.

Nerve conduction studies may show distal symmetrical polyneuropathy. EMG findings may show fibrillations in the paraspinous or abdominal wall muscles.

The prognosis is generally good with a gradual resolution of pain over months if glycaemic control can be achieved. The focus of treatment is pain relief typically with anti-neuropathic drugs and a diabetic management.

Opportunities for self-directed learning

This would be a good opportunity to review:

  • Presentation and classification of diabetic neuropathies
  • An understanding of nerve conduction studies and their usefulness in the investigation and management of pain.