Psychosocial Factors in Painful Diabetic Neuropathy: A Systematic Review of Treatment Trials and Survey Studies

Abstract

Objective Diabetes mellitus is associated with a number of complications that can adversely impact patients’ quality of life. A common and often painful complication is painful diabetic neuropathy. The aims of this study were to systematically review and summarize evidence from studies of psychological treatments and psychosocial factors related to painful diabetic neuropathy and assess the methodological quality of these studies. Methods Electronic databases, related reviews, and associated reference lists were searched. Summaries of participants’ data relating to the efficacy of psychological treatments and/or to associations between psychosocial factors and outcomes in painful diabetic neuropathy were extracted from the included studies. The methodological quality of included studies was assessed using two standardized quality assessment tools. Results From 2,921 potentially relevant titles identified, 27 studies were included in this systematic review. The evidence suggests that depression, anxiety, sleep, and quality of life are the most studied variables in relation to pain outcomes in painful diabetic neuropathy and are consistently associated with pain intensity. The magnitude of the associations ranged from small to large. Conclusions Research into psychosocial factors in painful diabetic neuropathy is unexpectedly limited. The available evidence is inconsistent and leaves a number of questions unanswered, particularly with respect to causal associations between variables. The evidence reviewed indicates that depression, anxiety, low quality of life, and poor sleep are associated with pain in painful diabetic neuropathy. The disproportionate lack of research into psychological treatments for painful diabetic neuropathy represents a significant opportunity for future research.

Prevalence and incidence of diabetic peripheral neuropathy in Latin America and the Caribbean: A systematic review and meta-analysis

“…DPN is a leading cause of worldwide disability [ 15 ], and it affects the quality of life due to chronic pain, high risk of falls [ 17 ], foot ulceration [ 18 ], and limb amputation [ 19 ]. Furthermore, DPN symptoms often lead to sleep disorders, anxiety, and depression [ 20 , 21 ]. The poor glycemic control causing hyperglycemia and microangiopathy is the common underlying pathophysiology.…”

The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial

“…According to Melzack's theory, psychological factors might affect pain severity perception, and pain could exist despite typical clinical examination results [15,16]. Kioskli et al in a systematic review, indicated that depression, anxiety, poor sleep, and low quality of life are consequences of PDN [17]. Various studies on chronic pain show that acceptance might improve pain management [18][19][20].…”

Sleep Characteristics in Diabetic Patients Depending on the Occurrence of Neuropathic Pain and Related Factors

“…Finally, it is worth highlighting that negative mood and anxiety are frequently observed processes in diabetic patients [15] and patients with neuropathic pain of different origins [16], and that the management and outcome of neuropathic pain in diabetic patients can worsen when these processes coexist with SD [2,17,18].…”