Painful diabetic neuropathy – Can you help?

The situation

We know that diabetes, and the complications that may accompany it, are becoming more common (1). A recent World Health Organisation study looking at the Disability Adjusted Life Years for a range of diseases showed diabetes has risen globally from 21^st in 1990, to 14^th in 2010 (2). Painful diabetic neuropathy (PDN) is one of the potential complications of diabetes and affects 6-34% of people with diabetes (3).

PDN is experienced as an unpleasant burning pain that is unpredictable and can have a large impact on people’s physical ability, mood state and overall quality of life (3). Recommendations for the management of PDN do not go beyond drug management (4), and we know that these drugs often fail to provide significant pain relief (5).

The cost of PDN to health services can be significant – the UK annual cost averages £2511 per patient, with drugs accounting for around 30% of this amount (3), yet non-drug options such as strategies from pain management programmes (PMPs) are not well researched (6).

The research

I’m currently undertaking a PhD under the expert supervision of  Candy McCabe (Uni West of England), Fiona Cramp (UWE) and Jeremy Gauntlett-Gilbert (Royal United Hospitals Bath).  As part of this, we interviewed 23 people who experience PDN, to explore how this complication impacts on their life and what their perspectives were on the idea of PMP strategies for the problems they experienced.

With respect to physical activity, participants wanted professional advice about activity, and they did not want to be made worse. There was a strong ambivalence to the idea that mood state could have any effect on their pain – it’s a nerve disease due to diabetes, stupid! Consequently, the role of psychological coping strategies was questioned and it was not clear that people with PDN would be open to PMP strategies.

To investigate this further, we created a list of impact statements that encapsulated the effect PDN has on the lives of the interview participants. We are currently running an internet survey study asking people with PDN to select which of these impacts they would most want help to manage better. We will then look to see if the highest priorities can be matched to existing strategies, or whether novel approaches may need to be developed.

How you can help

Can you help recruit people to this survey?

If you have, or know anyone with PDN, completing or sharing the survey at the links below will really help us to understand how best to help those people experiencing painful diabetic neuropathy.

To complete the survey, click on the link below:

An Internet survey investigating the impact of Painful Diabetic Neuropathy (PDN) and patient treatment priorities.

To share the link with someone, just copy and paste the quick link- https://tinyurl.com/gubvojz -into a message.

The survey closes at the end of April 2016.

-Ben Davies

Ben is currently a PhD candidate at University of the West of England. He is researching the role of physical rehabilitation in the management of painful diabetic neuropathy. Prior to this he worked for twelve years at Calderdale and Huddersfield NHS Trust as Clinical Lead Physiotherapist in Spinal and Chronic Pain. He is an experienced NOI Instructor, teaching Mobilisation of the Nervous System, Explain Pain and Graded Motor Imagery courses. 

1. Alberti KGMM, Zimmet P. Epidemiology: Global burden of disease—where does diabetes mellitus fit in? Nature Reviews Endocrinology. 2013;9(5):258–60.
2. Murray CJL, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380(9859):2197–223.
3. Alleman CJM, Westerhout KY, Hensen M, Chambers C, Stoker M, Long S, et al. Humanistic and economic burden of painful diabetic peripheral neuropathy in Europe: A review of the literature. Diabetes Research and Clinical Practice. 2015 Aug;109(2):215–25.
4. NICE. Neuropathic pain – pharmacological management The pharmacological management of neuropathic pain in adults in non-specialist. London: Centre for Clinical Practice at NICE; 2013.
5. Moore A, Derry S, Eccleston C. Expect analgesic failure; pursue analgesic success. British Medical Journal. 2013;2690(May):7–9.
6. Davies B, Cramp F, Gauntlett-Gilbert J, Wynick D, McCabe CS. The role of physical activity and psychological coping strategies in the management of painful diabetic neuropathy – A systematic review of the literature. Physiotherapy. 2015 Dec;101(4):319–26.