Painful diabetic neuropathy: Exploring management options
Painful diabetic neuropathy (PDN) is one microvascular complication of diabetes mellitus (DM) and the focus of this thesis. PDN is a neuropathic pain condition characterised by severe burning pain in the feet and sometimes hands. It has significant impacts on peoples’ mobility, sleep quality and overall quality of life. The personal and societal burden associated with DM and PDN is predicated to rise as prevalence rates increase.
Pharmacological management of PDN is often less than optimal, and people are left with few strategies to cope. Multidisciplinary pain management programmes (PMPs) use physical activity and psychological coping strategies to help people live better with persistent pain, yet people with PDN are rarely referred. It is unknown whether these strategies would be appropriate to help people live with PDN.
This thesis aimed to: 1) locate and appraise all literature relating to physical activity and psychological coping strategies in PDN; 2) interview people with PDN and explore how PDN impacted on their lives; 3) explore the perspectives of patients and clinicians on the relevance of PMP approaches; and 4) explore patients’ treatment priorities and whether these might be addressed by PMP strategies.
To address these aims, firstly a systematic literature review was conducted. The review identified a paucity of studies investigating physical activity or psychological coping strategies for PDN. Two interview studies were conducted, and data were analysed using thematic analysis (TA). A study with patients (n=23) found the impacts of PDN were wide ranging, people had experimented with many coping strategies unsuccessfully and there was some scepticism that PMP strategies were relevant to PDN, though few participants had direct experience of them. The second study interviewed specialist diabetes and pain clinicians and representatives from primary care (n=19). Clinicians relied primarily on medication strategies and did not have alternatives when these failed. Diabetes clinicians highlighted that people with PDN were medically complex patients and were at risk of tissue damage from too much physical activity. Pain clinicians felt PMP strategies could be adapted to suit the population with PDN.
Informed by the patient interview study, an Internet survey was developed to explore the management priorities of people with PDN (n=63 respondents). Sleep disturbance was the top priority in all subgroups analysed. There were six impacts most frequently prioritised by respondents, which did not include pain. Potential clinical management strategies for these impacts have been described, and suggestions made for future research.
This thesis has shown a scarcity of existing evidence for non-pharmacological strategies in the management of PDN. PMP strategies were not necessarily viewed as appropriate by patient participants. The impacts prioritized by people with PDN could however be matched to management strategies from other conditions where persistent pain is common. There is no a priori reason why these strategies could not be trialled with PDN. Managing the impacts of PDN on peoples’ lives remains a complex process.
Davies, B. Painful diabetic neuropathy: Exploring management options. (Thesis). University of the West of England
|Keywords||Diabetes, Neuropathy, Pain, Rehabilitation|
Main thesis document - final (2).pdf