Pain Severity in Diabetic Peripheral Neuropathy is Associated with Patient Functioning, Symptom Levels of Anxiety and Depression, and Sleep

Gore, Mugdha; Brandenburg, Nancy A.; Dukes, Ellen; Hoffman, Deborah; Tai, Kei Sing; Stacey, Brett R.

doi:10.1016/j.jpainsymman.2005.04.009

Cited by 452 publications

(402 citation statements)

References 60 publications

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“…Compared with earlier reports [10,35], in our sample there were fewer cases of moderate to severe depression. It is important to note, however, that in the earlier studies patients were selected based on severe neuropathic complications, i.e.…”

Section: Discussioncontrasting

confidence: 88%

“…It is important to note, however, that in the earlier studies patients were selected based on severe neuropathic complications, i.e. they had diabetic foot syndrome [35] or unremitting neuropathic pain [10], and therefore are not comparable to our population, which was selected based on clinical tests of neuropathic deficits (NDS and VPT) and not the presence of severe neuropathic complications. Indeed, a substantial proportion of our patients were symptom-free.…”

Section: Discussionmentioning

confidence: 99%

“…Evidence from individual studies [7][8][9][10], supported by a meta-analysis [11], suggests that there is a link between DPN and depressive symptoms. However, previous studies have focused almost exclusively on severe neuropathic pain, even though less than a third of patients with DPN experience painful symptoms [12] and many experience no symptoms [13].…”

Section: Introductionmentioning

confidence: 99%

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Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

et al. 2009

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Aims/hypothesis The aim of the study was to determine whether diabetic peripheral neuropathy (DPN) is a risk factor for depressive symptoms and examine the potential mechanisms for this relationship. Methods This longitudinal study (9 and 18 month followup) of 338 DPN patients (mean age 61 years; 71% male; 73% type 2 diabetes) examined the temporal relationships between DPN severity (mean±SD; neuropathy disability score [NDS], 7.4±2.2; mean vibration perception threshold, 41.5±9.5 V), DPN somatic experiences (symptoms and foot ulceration), DPN psychosocial consequences (restrictions in activities of daily living [ADL] and social selfperception) and the Hospital Anxiety and Depression subscale measuring depressive symptoms (HADS-D; mean 4.9±3.7).Results Controlling for baseline HADS-D and demographic/disease variables, NDS at baseline significantly predicted increased HADS-D over 18 months. This association was mediated by baseline unsteadiness, which was significantly associated with increased HADS-D. Baseline ADL restrictions significantly predicted increased HADS-D and partly mediated the association between baseline unsteadiness and change in HADS-D. Increased pain, unsteadiness and ADL restrictions from baseline to 9 months each significantly predicted increased HADS-D over 18 months. Change in social self-perception from baseline to 9 months significantly predicted increased HADS-D and partly mediated the relationships of change in unsteadiness and ADL restrictions with change in HADS-D. Conclusions/interpretation These results confirm that neuropathy is a risk factor for depressive symptoms because it

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Section: Discussioncontrasting

confidence: 88%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

et al. 2009

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“…Chronic pain can have a significant impact on a patient's daily life (Gore et al, 2005); consequently, effective pain relief is highly warranted. Experiments investigating pain in human subjects have intrinsic ethical and practical difficulties; accordingly, early analgesic development relies on animal models (Mogil, 2009).…”

Section: Introductionmentioning

confidence: 99%

Burrowing as a non‐reflex behavioural readout for analgesic action in a rat model of sub‐chronic knee joint inflammation

Rutten¹,

Schiene²,

Robens³

et al. 2013

European Journal of Pain

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Background: Innate responses against spontaneous pain are proposed to improve the predictive validity of preclinical analgesia models. Therefore, development and validation of novel readouts is necessary. To investigate whether innate rodent burrowing is a useful alternative behavioural readout for assessment of analgesic efficacy, a complete Freund's adjuvant (CFA)-induced model of sub-chronic inflammation was used to compare the effects of naproxen, ibuprofen and pregabalin in weight-bearing (WB), open-field (OF) and burrowing assays. Methods: Male Sprague Dawley rats were injected with 150 μL of CFA (2 mg/mL) into the knee (hind leg) 3 days before testing. Naproxen, ibuprofen and pregabalin were administered at different doses 30, 90 and 60 min, respectively, before testing. WB was determined using a rat incapacitance tester; horizontal distance moved and vertical rearings were recorded in an OF; and burrowing was measured by the weight of gravel remaining in a hollow tube after 60 min. Results: CFA-induced arthritis reduced WB, OF activity and burrowing. Naproxen, pregabalin and ibuprofen treatment normalized WB; however, horizontal OF activity was not improved by any treatment; rearing behaviour was moderately reinstated by ibuprofen (100 mg/kg). In burrowing, naproxen (100 mg/kg), ibuprofen (31.6 and 100 mg/kg) and pregabalin (10 mg/kg) reversed CFA-induced deficits. Conclusions: Burrowing performance is an alternative non-reflex readout relying on innate rodent behaviour that is affected by nociceptive behaviour and can be pharmacologically manipulated. The burrowing assay appears to be more sensitive than OF assays and is as sensitive as WB assays at distinguishing between analgesic doses and doses that impair locomotion.

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“…Gore et al 16 presented data that directly compared emotional and physical functioning of community samples of people with diabetes mellitus and individuals with diabetic painful neuropathies ( Figure). On each measure, people with diabetes reported diminished emotional functioning.…”

mentioning

confidence: 99%

Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

Turk

Audette

Levy

et al. 2010

Mayo Clinic Proceedings

144

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[3][4][5] In some studies, investigators reported that more than 40% of patients with implanted devices for pain control experience adverse events 6 ; up to 67.7% of patients treated with lumbar surgery for back pain reported that their pain was worse after surgery, 7 and at least moderate adverse effects have been reported to occur in 30% to 61% of all patients who undergo spinal manipulations. 8 These findings do not argue against the use of such treatments but serve as reminders of limitations and possible harmful effects. The mean duration of pain in patients who seek treatment at chronic pain treatment facilities is approximately 7 years. 9 Consequently, all domains of their lives may have been compromised for a substantial amount of time. It is hardly surprising that levels of emotional distress for patients with persistent pain are high. Estimates suggest that at least 1 current psychiatric diagnosis is present in 59% of patients with chronic back pain treated at pain facilities and at least 1 lifetime psychiatric diagnosis is present in 77% of these patients. 10 In contrast, community estimates are 15% for at least 1 current psychiatric diagnosis and 29% to 38% Chronic neuropathic pain is a prevalent problem that eludes cure and adequate treatment. The persistence of intense and aversive symptoms, inadequacy of available treatments, and impact of such pain on all aspects of functioning underscore the important role of several psychosocial factors in causing, maintaining, and amplifying the perception of pain severity, coping adequacy, adaptation, impaired physical function, and emotional distress responses. Moreover, these factors have an influential role in response to treatment recommendations. In this article, we (1) review the prevalence and nature of emotional distress, (2) describe and propose methods for screening and comprehensive psychosocial assessment, and (3) review evidence supporting the potential complementary role of psychosocial treatments of patients with chronic pain. The cognitive-behavioral perspective and treatment approach are emphasized because the greatest amount of evidence supports their benefits. Published results of psychological treatments are modest; however, the same indictment can be placed on currently available pharmacological, medical, and interventional treatments for patients with chronic pain. We note the limited research on the effectiveness of psychological treatment specifically applied to patients with chronic neuropathic pain but suggest that it is reasonable to extrapolate from successful trials in other types of chronic pain. Furthermore, psychological approaches should not be viewed as alternatives but rather should be integrated as part of a comprehensive approach to the treatment of patients with chronic neuropathic pain. Mayo Clin © 2010 Mayo Foundation for Medical Education and ResearchC hronic neuropathic pain is a prevalent problem that eludes successful treatment. Despite increasing knowledge of the neurophysiologic factors underlying neuropathic pa...

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Pain Severity in Diabetic Peripheral Neuropathy is Associated with Patient Functioning, Symptom Levels of Anxiety and Depression, and Sleep

Cited by 452 publications

References 60 publications

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

Predictors of depressive symptoms in persons with diabetic peripheral neuropathy: a longitudinal study

Burrowing as a non‐reflex behavioural readout for analgesic action in a rat model of sub‐chronic knee joint inflammation

Assessment and Treatment of Psychosocial Comorbidities in Patients With Neuropathic Pain

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