Thoracic Nerve Neuropathy and Abdominal Pain in Diabetes Mellitus

Yes, neuropathy of thoracic nerves causing abdominal muscles denervation can cause abdominal pain in patients with diabetes mellitus. 1, 2, 3

Pathophysiology and Clinical Presentation

Diabetic thoracic polyradiculopathy can affect thoracic spinal nerves, leading to denervation of abdominal wall muscles and resulting in pain and sensory symptoms 1, 3
This condition is characterized by sudden onset of pain involving several adjacent dermatomal segments, which can be unilateral or bilateral and often asymmetrical 2
Patients may present with various types of abdominal pain that is typically worse at night and aggravated by light pressure 3
Physical examination often reveals cutaneous sensory abnormalities in the affected area, and some patients develop localized abdominal wall paresis with protrusion or swelling 3, 4
Significant weight loss may accompany the pain symptoms and typically reverses after pain relief 2, 3

Diabetic neuropathy, including thoracic polyradiculopathy, is a diagnosis of exclusion 5
Electromyography (EMG) showing thoracic paraspinal muscle denervation is a key diagnostic finding 1, 3
Truncal EMG is typically abnormal in patients with thoracic polyradiculopathy 2
Other causes of abdominal pain should be excluded through appropriate gastrointestinal investigations before attributing symptoms to diabetic thoracic neuropathy 1, 3
The condition may be part of a more diffuse neuropathic process that also involves peripheral nerves of the limbs and the autonomic nervous system 2

Thoracic polyradiculopathy often occurs in the context of other diabetic complications 3
Autonomic nervous system involvement is common, with abnormal sympathetic skin response and cardiac denervation frequently observed 2
The condition predominantly affects middle-aged individuals and may involve three to five adjacent nerve roots between T6 and T12 4
In some cases, abdominal wall muscle herniation or bulging may be observed due to muscle weakness 4

Optimizing glucose control is essential to prevent or delay the development of neuropathy in patients with type 1 diabetes and to slow progression in type 2 diabetes 5
For neuropathic pain management, pregabalin or duloxetine are recommended as initial pharmacologic treatments 5, 6
Tricyclic antidepressants like amitriptyline have shown effectiveness in providing marked pain relief within one week in some patients with diabetic thoracic neuropathy 2, 6
Gabapentin (300-1,200 mg three times daily) is another recommended option for managing neuropathic pain 6
Aldose reductase inhibitors have been associated with good clinical response of symptoms due to peripheral neuropathy and thoracic polyradiculopathy in some case reports 1

The natural history of diabetic thoracic polyradiculopathy typically involves spontaneous recovery within 3 to 12 months 3, 4
However, recurrence of polyradiculopathy can occur in some patients 3
Early recognition of this condition can prevent unnecessary and expensive diagnostic evaluation for visceral causes of pain 3

Diabetic thoracic polyradiculopathy is often unfamiliar to many clinicians, leading to extensive negative gastrointestinal investigations before the correct diagnosis is made 1, 3
The condition can be mistaken for intra-abdominal pathology, resulting in delayed diagnosis and appropriate treatment 1
Weight loss associated with this condition might be incorrectly attributed to poorly controlled diabetes or other causes 4
Opioids should generally be avoided for chronic neuropathic pain due to risk of addiction 6
Adverse events from medications may be more severe in older patients but can be attenuated with lower starting doses and slower titration 6