Acute painful neuropathies begin relatively acutely at any stage of diabetes, sometimes paradoxically eight to 12 weeks after starting insulin, or as the presentation of Type 2 diabetes. The acute and persistent pain can be disabling. Distribution of the pain is radicular over the territory of several adjacent nerve roots, affecting either the legs or the abdominal wall (the latter very rarely accompanied by muscle bulging from motor weakness). The thighs are affected in patients with femoral neuropathy. Both feet and legs can be affected symmetrically in a "stocking" distribution. Patients usually recover from these neuropathies in a period of six to 18 months. These neuropathies occur independently of peripheral sensory or autonomic neuropathy.
The pain causes exceptional distress because it is protracted and unremitting. Constant burning sensations, paraesthesiae or shooting pains occur, but the most characteristic symptom is a cutaneous hypersensitivity (allodynia) leading to acute discomfort on contact with clothing and bedclothes. The pain leads to insomnia and depression, and is sometimes accompanied by catastrophic weight loss. Patients are so distressed that they may seek several opinions on their condition, and often believe that they must have a malignant disease.
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