Psychosocial Aspects of Diabetic Neuropathy: From Description to Interventions

Abstract

Diabetic distal symmetric polyneuropathy (DPN), especially when accompanied by pain, has a wide-reaching impact on the lives of people, with decrements in physical and mental functioning, participation in activities of daily living, employment, and overall quality of life (QoL). Pain catastrophizing and psychological flexibility are among other psychological constructs hypothesized to impact persons’ adaptation to painful DPN. Furthermore, a set of specific fears related to DPN experience is also prominent (e.g., fear of falling and fear of worsening of pain) and is associated with increased disability and reduced QoL. Unlike painful DPN, postural instability is a largely underappreciated clinical manifestation of neuropathy. Nonetheless, DPN-postural instability is a key determinant of depressive symptoms. These findings have important implications for the care of people with DPN. They define several possible psychosocial routes linking DPN to depression/anxiety and impaired QoL, thereby providing clinicians with the specific points for interventions to alleviate emotional distress and improve QoL. While most of the existing treatments to-date are focused on pharmacological management of painful DPN, over the past decade there has been a steady increase in studies testing psychological interventions to manage pain in DPN sufferers. These include cognitive behavioral therapy and its modifications, including mindfulness-based stress reduction and the acceptance and commitment therapy. Although these are mostly small pilot and feasibility studies, nonetheless, as indicated by recent systematic reviews, these psychological therapies have a significant beneficial effect on pain severity, pain interference, depressive symptoms, and QoL in adults with painful DPN. Larger trials with sufficient statistical power are needed to confirm or refute the effectiveness of these interventions on the experience of pain and their impact on the quality of life of people with DPN. Future research should also rigorously test the effectiveness of blended care, where online psychological support is offered in combination with clinical care.