Chao CC, Tseng MT, Hsieh PC, et al. - Results suggest that changes in brain structural connectivity (SC) may be a form of maladaptive plasticity following peripheral nerve injury, and also reveal a pathophysiological link between disconnection of the limbic circuitry and pain and autonomic dysfunction in diabetes.

• This study included 25 painful (PDN) and 13 painless (PLDN) diabetic neuropathy patients, and 27 healthy adults (controls).

• Significantly lower thalamic and hypothalamic SC of the right amygdala was detected in PDN patients vs PLDN and control groups.

• An association was found between lower thalamic SC of the insula and more severe peripheral nerve degeneration.

• Greater autonomic dysfunction manifested by reduced heart rate variability was observed in relation to lower hypothalamic SC of the anterior cingulate cortex.