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The resurgence of pinprick testing

By Samuel Kolodney 2 years ago 1293 Views No comments

Pinprick is a medically useful modality 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

(Boulton et al, 2008, 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 vol. 31 no. 8 1679- 1685:

Pinprick sensation. Similarly, the inability of a subject to perceive pinprick sensation has been associated with an increased risk of ulceration. A disposable pin should be applied just proximal to the toenail on the dorsal surface of the hallux, with just enough pressure to deform the skin. Inability to perceive pinprick over either hallux would be regarded as an abnormal test result.”1

Pinprick sensory testing, whether in the doctors’ office or at the patient’s home, is a very simple procedure. By contrast the technique required for monofilament testing consistent with instructions published by the ADA is more complicated and whilst easy enough in the clinical setting, remains challenging to perform accurately in a self-care situation.

Testing sensation with a Medipin clearly represents the simplest and easily executed technique to perform in the home and empowers patients to participate in an important aspect of their own diabetic healthcare. As a testing modality for the prediction of serious diabetic complications, like the development of lower extremity ulceration, pinprick has actually been reputably demonstrated to be rather more sensitive than conventionally used techniques.

The study Abbott et al, 2002, The North-West Diabetes Foot Care Study: Incidence Of, And Risk Factors For New Diabetic Foot Ulceration In A Community Based Patient Cohort. Diabet Med 19: 377–384) utilised a population of almost 10,000 patients. This significant study undertaken at one of the most prolific neuropathy centres in the world, Withington, Central Manchester University Hospitals, UK, showed that pinprick was even more useful for predicting the development of foot ulceration than more conventional techniques including monofilament.

Rather than be dismissed for its relative obscurity, pinprick should be embraced as a clinically useful tool in helping patients with diabetes to monitor themselves for loss of protective sensation. Virtually all health care professionals working and studying in this area similarly express the view that anything that alters foot self-care behavior in diabetes has got to be a good thing. We believe that Medipin will massively encourage education and better self-care practice and all the undoubted benefits that come with it.

Medipin is an FDA listed, dedicated device which has been in regular use by US Doctors for many years, as well has having been employed successfully in quite a number of international medical studies. It is an all-plastic precision instrument which was designed to avoid skin puncture whilst, simultaneously, significantly heightening stimulation at lower application pressures by exploiting neural lateral inhibition. A specially faceted and blunted point is situated within a surrounding annular component that serves to both micro stretch the skin and create an artificial center surround field.

To summarise;

  1. Home testing for diabetic neuropathy has excellent potential to transform self-management strategy of the diabetic foot in the USA and elsewhere.
  2. Whilst pinprick has not been the historic primary choice of testing modality for diabetic neuropathy, as much though fashion and neglect rather than appropriate scrutiny it remains, nonetheless, acknowledged as a potent, justifiably efficacious and ADA recommended test.
  3. Pinprick sensation testing using the technique recommended in the ADA's guidelines and performed with a Medipin, is probably the easiest test for patients to do in the home.
  4. If the spirit of ADA assessment were to be taken to the fullest degree the optimum scenario for home testing would be to offer the patient an option to perform a pinprick test with Medipin with the addition of a simple disposable monofilament test or instructions for the ‘Ipswich Touch Test’ which has been shown to be as efficacious as the monofilament and requires no extra equipment at all: (Rayman G, Vas PR, Baker N, et al. The Ipswich Touch Test: a simple and novel method to identify inpatients with diabetes at risk of foot ulceration. Diabetes Care. 2011;34:1517-1518)

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