Case of the Month #5: Thoracoabdominal Neuropathic Pain

Published: 16/04/2021

Clinical progress

The MRI of his brain and spine was normal, showing no mass or inflammatory lesions.

The HbA1c was 87 mmol/mol indicating poorly controlled diabetes and gives an indication of diabetic control over the preceding 3 months. An ideal HbA1c level is 48 mmol/L or below.

Nerve conduction studies showed slightly reduced lower limb sensory responses. There was no evidence of denervation to the thoracic or truncal muscles.

Further investigations by the neurology team including a lumbar puncture were normal.

A working diagnosis of thoracoabdominal neuropathy due to poorly controlled diabetes was made. Unfortunately, there was no benefit from gabapentin or pregabalin. Duloxetine provided partial relief.

The pain gradually improved with an improvement in glycaemic control.