Abnormal perception of pain is common in Diabetic Peripheral Neuropathy (DPN). The pathogenesis remains poorly understood. Abnormalities in peripheral nerve physiology have been extensively documented. Recently, Magnetic Resonance Imaging (MRI) and Spectroscopy (MRS) have shown CNS involvement, an understanding of which may influence treatment development. This work investigates the brain's response to pain stimulation in patients with Diabetes Mellitus, using Blood Oxygen-Level Dependent (BOLD) fMRI to monitor the functional neuroanatomical correlates to heat-pain stimuli. Twelve males (mean age=54±12yrs) with diabetes took part: 4 without DPN; 4 with painful DPN and 4 with painless DPN (Dyck's criteria). Heat-pain stimulation was provided by an MR-compatible peltier-type device and pain perception was recorded prior to imaging. Whole-brain 3T fMRI datasets were acquired using echo-planar technique. One functional run was performed for each subject. A boxcar paradigm comprised 3 epochs, each including 30sec baseline (35°C), 30sec warmth (40-43°C) and 30 sec heat-pain (47-49°C). Images were analysed using Statistical Parametric Mapping (UCL, London) which yielded brain maps depicting statistically significant differences in BOLD response between baseline and heat-pain conditions. Analysis indicates differences in the brain's BOLD haemodynamic response to heat-pain between subject groups at different stages of DPN (P<0.05). Those without DPN showed greater response than those with DPN, for the condition that hot stimulation returned greater response than baseline temperature. Subjects who had painful DPN showed greater response than those who had painless DPN, for the same condition. Differences occurred within the frontal lobe, often associated with perception and cognitive function; cerebellum, which may implicate processing speed action, and the primary somatosensory cortex. Further correlative analyses are required to assess whether BOLD response is coupled with degree of acute and chronic pain plus other physiological and clinical measures. [ABSTRACT FROM AUTHOR]