Prevalence of pain and association with quality of life, depression and glycaemic control in patients with diabetes

Abstract

Aims To determine the prevalence of pain and its association with glycaemic control, mental health and physical functioning in patients with diabetes.Methods Cross-sectional data from a multi-site, prospective cohort study of 11 689 participants with diabetes. We analysed the associations of pain severity and interference with glycated haemoglobin (HbA 1c ) measurements and Medical Outcomes Study SF-Mental and Physical Component Summary-12 (MCS-12 and PCS-12) scores.Results Of participants, 57.8% reported moderate to extreme pain and, compared with those without pain, were somewhat older (60.8 vs. 59.9 years, P < 0.001), more obese (body mass index of 32.1 vs. 29.8 kg ⁄ m 2 , P < 0.001), more likely to report being depressed or anxious (41.3 vs. 16.2%, P < 0.001) and more likely to report fair or poor health (48.5 vs. 23.1%, P < 0.001). Bivariate comparisons demonstrated that patients with extreme pain had higher HbA 1c than those without pain (8.3 vs. 8.0%, P = 0.001). In multivariable analyses, pain was not associated with HbA 1c (P = 0.304) but was strongly associated with worse MCS-12 (P < 0.001), PCS-12 (P < 0.001) and depression (P < 0.001). Depression was 1.3 (95% CI: 1.12, 1.96) times more likely in patients with moderate pain and 2.0 (95% CI: 1.56, 2.46) times more likely in patients with extreme pain.Conclusions Moderate to extreme pain was present in 57.8% of diabetic patients. Pain was strongly associated with poorer mental health and physical functioning, but not worse glycaemic control. Recognizing the high prevalence of pain and its strong association with poorer health-related quality of life may be important to improve the comprehensive management of diabetes.Diabet. Med. 27, 578-584 (2010)

Cough in the Elderly Population: Relationships with Multiple Comorbidity

“…Our relationships with high HbA1C levels further suggest diabetes mellitus, especially uncontrolled, needs to be considered as a potential risk factor for cough, particularly in the elderly population. There is still a paucity of studies investigating the associations between HbA1c and non-diabetic, or non-cardiovascular conditions; however, high HbA1c was positively related to reflux symptom episodes in adolescents [34], and also was independently associated with the increased prevalence of pain [35,36]. …”

A difficult combination: chronic physical illness, depression, and pain

“…Similarly, pain and depression commonly coexist. It has been shown that there is a 2.5-10 times increase in anxiety or major depression in patients with pain, 4 that pain in diabetes is strongly associated with depression (P<0.001), 5 and that the onset of depression is associated with an increasing number of pain locations (P<0.001) and higher severity of pain (P<0.001). 6 Furthermore, there is concern that presence of pain negatively affects recognition and treatment of depression: depressed patients are more likely to present with pain symptoms than low mood.…”

Chronic Low-Grade Inflammation in Metabolic Disorders: Relevance for Behavioral Symptoms

“…In patients with metabolic disorders, symptoms of fatigue were found to concern primarily the dimensions of general and physical fatigue [30]. Similar to fatigue, sleep disorders and pain were found to concern a significant proportion of patients with metabolic alterations (above 60%), with a greatest prevalence in obese subjects [31,32,33]. …”