Psychological considerations for patients with painful diabetic neuropathy

According to a narrative review published in Diabetes Therapy, clinicians should evaluate patients with painful diabetic neuropathy (pDN) for their mental health before deciding on their treatment plans.

This review was based largely on a presentation given by Dr. Hannah Twiddy of the Walton Center during the 4th UK Symposium on Diabetic Neuropathy held at the University of Liverpool in the UK in November 2019.

Painful diabetic neuropathy is a debilitating condition. Treatment includes pharmacotherapy aimed at producing pain. Satisfactory results are defined as greater than 50% improvement in pain. However, a significant number of patients do not reach this milestone.

Many patients have mental illnesses at the same time, including mental comorbidities and insomnia. A two-way relationship between pain and mental symptoms can make pDN worse, and physicians should use great care in devising a treatment plan for these patients.

The Walton Center Pain Management Program has developed a 3-point assessment list: 1) improving and improving the quality of life of patients with chronic pain, 2) changing behavior directly or indirectly with cognitive or behavioral therapy, and 3) assessing improvements in the long term and short term. This list was created to encompass 5 areas of pDN disease: pain, pain perceptions, pain behavior, emotional distress, and social context.

To ensure that treatment plans cover all areas of the disease, patients are consulted by 4 clinicians: a pain advisor, a clinical psychologist, a physical therapist, and an occupational therapist. After the 4 hour assessment, the clinicians have a multidisciplinary conference to discuss an individual care package for each patient.

Compared to musculoskeletal pain, neuropathic pain is less predictable and must be viewed in the context of existing comorbidities or, in this case, diabetes. Previous studies have linked worsening symptoms of diabetes to increased depression and poor self-care.

The Walton Center is a proponent of Acceptance and Attachment Therapy (ACT), a third wave of cognitive behavioral therapy that focuses on mindfulness strategies in addition to a commitment to changing unwanted behaviors.

In all cases, patients should be screened for treatment outcomes using established tools such as Beck’s Depression Inventory Second Edition or Diagnostic and Statistical Manual of Mental Disorders IV.

The narrative review authors concluded that in addition to assessing pain in patients with pDN and creating a treatment plan, clinicians should assess patients to determine whether their expectations are realistic and whether they should refer to a mental health team or need multidisciplinary pain. In short, a holistic approach is required for all patients with pDN as the patient’s psychological state can have a significant impact on their perception of pain.


Twiddy H, Frank B, Alam U. A Consideration of the Psychological Aspects of Treating Patients with Painful Diabetic Neuropathy: An Inside Look at Pain Management Services at a tertiary center in the UK. Diabetes Ther. 2021; 12 (2): 487- 498. doi: 10.1007 / s13300-020-00983-y

This article originally appeared on Clinical Pain Advisor

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