Skip to main content

Advertisement

SpringerLink
Log in

Painful Diabetic Neuropathy is More than Pain Alone: Examining the Role of Anxiety and Depression as Mediators and Complicators

  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

A wealth of information exists regarding the plight of patients suffering with diabetic peripheral neuropathic pain (DPNP). Although physical pain is certainly a primary challenge in the management of this condition, disorders associated with emotional pain—especially depression and anxiety—also greatly complicate the clinician’s efforts to attain optimal outcomes for DPNP patients. This article reviews the high rate of comorbidity between DPNP and depression/anxiety with a focus on why this pattern of comorbidity exists and what can be done about it. To accomplish this, the many physiologic similarities between neuropathic pain and depression/anxiety are reviewed as a basis for better understanding how, and why, optimal treatment strategies use behavioral and pharmacologic modalities known to improve both physical pain and symptoms of depression and anxiety. We conclude by highlighting that screening, diagnosing, and optimally treating comorbid depression/anxiety not only improves quality of life, these but also positively impacts DPNP pain.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Daly M. Diabetes and depression–a risky combination. Nurs N Z. 2010;16(2):14–5.

    PubMed  Google Scholar 

  2. • Bair MJ et al. Prevalence of pain and association with quality of life, depression and glycaemic control in patients with diabetes. Diabet Med. 2010; 27(5):578–84. This article demonstrates the significant association between diabetes and pain.

    Article  PubMed  CAS  Google Scholar 

  3. Kessler RC, McGonagle KA, Zhao S, Nelson CB. Lifetime and 12 month prevalence of DSM-III-R psychiatric disorders in the United States. Arch Gen Psychiatry. 1994;51:8–19.

    PubMed  CAS  Google Scholar 

  4. Michaud CM, Murray CJ, Bloom BR. Burden of disease - implications for future research. JAMA. 2001;285(5):535–9.

    Article  PubMed  CAS  Google Scholar 

  5. Vehik K, Dabelea D. The changing epidemiology of type 1 diabetes: why is it going through the roof? Diabetes Metab Res Rev. 2010.

  6. Farag YM, Gaballa MR. Diabesity: an overview of a rising epidemic. Nephrol Dial Transplant. 2011;26(1):28–35.

    Article  PubMed  Google Scholar 

  7. • Li C et al. Diabetes and anxiety in US adults: findings from the 2006 behavioral risk factor surveillance system. Diabet Med. 2008; 25(7):878–81. This article articulates the issue of anxiety disorders in adults with diabetes.

    Article  PubMed  CAS  Google Scholar 

  8. Collins MM, Corcoran P, Perry IJ. Anxiety and depression symptoms in patients with diabetes. Diabet Med. 2009;26(2):153–61.

    Article  PubMed  CAS  Google Scholar 

  9. Gore M, Brandenburg N, Dukes E, Hoffman DL, Tai KS, Stacey B. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manage. 2005;30(4):374–85.

    Article  PubMed  Google Scholar 

  10. de Groot M, Anderson R, Freedland KE, Clouse RE, Lustman PJ. Association of depressive and diabetic complications: a meta-analysis. Psychosom Med. 2001;63(4):619–30.

    PubMed  Google Scholar 

  11. Waitzfelder B et al. Correlates of depression among people with diabetes: The Translating Research Into Action for Diabetes (TRIAD) study. Prim Care Diabetes. 2010;4(4):215–22.

    Article  PubMed  Google Scholar 

  12. Pouwer F et al. Prevalence of comorbid depression is high in out-patients with Type 1 or Type 2 diabetes mellitus. Results from three out-patient clinics in the Netherlands. Diabet Med. 2010;27(2):217–24.

    Article  PubMed  CAS  Google Scholar 

  13. Yoshida S et al. Neuropathy is associated with depression independently of health-related quality of life in Japanese patients with diabetes. Psychiatry Clin Neurosci. 2009;63(1):65–72.

    Article  PubMed  Google Scholar 

  14. Sulaiman N, Handam A, Tamim H, Mahmood DA, Young D, The prevalence and coorelates of depression and anxiety in a sampe of diabetic patients in Sharjah, United Arab Emirates. BMC Fam Pract. 2010; 11.

  15. Raval A, Dhanaraj E, Bhansali A, Grover S, Tiwari P. Prevalence and determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res. 2010;132:195–200.

    PubMed  Google Scholar 

  16. Wagner JA, Tennen H, Osborn CY. Lifetime depression and diabetes self-management in women with Type 2 diabetes: a case-control study. Diabet Med. 2010;27(6):713–7.

    Article  PubMed  CAS  Google Scholar 

  17. Katon WJ et al. The relationship between changes in depression symptoms and changes in health risk behaviors in patients with diabetes. Int J Geriatr Psychiatry. 2010;25(5):466–75.

    Article  PubMed  Google Scholar 

  18. Rubin RR et al. Cardiovascular disease risk factors, depression symptoms and antidepressant medicine use in the Look AHEAD (Action for Health in Diabetes) clinical trial of weight loss in diabetes. Diabetologia. 2010;53(8):1581–9.

    Article  PubMed  CAS  Google Scholar 

  19. Ahola AJ et al. Depression is associated with the metabolic syndrome among patients with type 1 diabetes. Ann Med. 2010;42(7):495–501.

    Article  PubMed  Google Scholar 

  20. Raval A et al. Prevalence & determinants of depression in type 2 diabetes patients in a tertiary care centre. Indian J Med Res. 2010;132:195–200.

    PubMed  Google Scholar 

  21. Herzer M, Hood KK. Anxiety symptoms in adolescents with type 1 diabetes: association with blood glucose monitoring and glycemic control. J Pediatr Psychol. 2010;35(4):415–25.

    Article  PubMed  Google Scholar 

  22. Le TK, Able SL, Lage MJ. Resource use among patients with diabetes, diabetic neuropathy, or diabetes with depression. Cost Eff Resour Alloc. 2006;4:18.

    Article  PubMed  Google Scholar 

  23. Boulanger L, Zhao Y, Bao Y, Russell MW. A retrospective study on the impact of comorbid depression or anxiety on healthcare resource use and costs among diabetic neuropathy patients. BMC Health serv Res. 2009; 9(111).

  24. Lin EH et al. Depression and advanced complications of diabetes: a prospective cohort study. Diabetes Care. 2010;33(2):264–9.

    Article  PubMed  Google Scholar 

  25. Ali S et al. The association between depression and health-related quality of life in people with type 2 diabetes: a systematic literature review. Diabetes Metab Res Rev. 2010;26(2):75–89.

    Article  PubMed  Google Scholar 

  26. •• Pouwer F, Kupper N, Adriaanse MC. Does emotional stress cause type 2 diabetes mellitus? A review from the European Depression in Diabetes (EDID) Research Consortium. Discov Med. 2010; 9(45):112–8. This thought-provoking article asks an important question: does stress act as a catalyst for the development of type 2 diabetes (and presumably its complications) in a prospective fashion?

    PubMed  Google Scholar 

  27. • Pan A et al. Bidirectional association between depression and type 2 diabetes mellitus in women. Arch Intern Med. 2010; 170(21):1884–91. This article offers a well-reasoned look at the data on the bi-irectional nature of diabetes and depression.

    Article  PubMed  Google Scholar 

  28. Atlantis E et al. Diabetes incidence associated with depression and antidepressants in the Melbourne Longitudinal Studies on Healthy Ageing (MELSHA). Int J Geriatr Psychiatry. 2010;25(7):688–96.

    Article  PubMed  Google Scholar 

  29. Nouwen A et al. Type 2 diabetes mellitus as a risk factor for the onset of depression: a systematic review and meta-analysis. Diabetologia. 2010;53(12):2480–6.

    Article  PubMed  CAS  Google Scholar 

  30. Vinik AI et al. Diabetic neuropathy in older adults. Clin Geriatr Med. 2008;24(3):407–35. v.

    Article  PubMed  Google Scholar 

  31. Costigan M, Scholz J, Woolf CJ. Neuropathic pain: a maladaptive response of the nervous system to damage. Annual Review of Neuroscience. 2009;32(1):1–32.

    Article  PubMed  CAS  Google Scholar 

  32. • Doupis J et al. Microvascular reactivity and inflammatory cytokines in painful and painless peripheral diabetic neuropathy. J Clin Endocrinol Metab. 2009; 94(6):2157–63. This is an excellent review of the issue of inflammatory cytokines in DPNP.

    Article  PubMed  CAS  Google Scholar 

  33. Scholz J, Woolf CJ. Can we conquer pain? Nat Neurosci. 2002;5(Suppl):1062–7.

    Article  PubMed  CAS  Google Scholar 

  34. Scholz J, Woolf CJ. The neuropathic pain triad: neurons, immune cells and glia. Nat Neurosci. 2007;10(11):1361–8.

    Article  PubMed  CAS  Google Scholar 

  35. • Maletic V, Raison CL. Neurobiology of depression, fibromyalgia and neuropathic pain. Front Biosci. 2009; 14:5291–338. This article offers a comprehensive review of the shared neurobiology of pain and depression.

    Article  PubMed  CAS  Google Scholar 

  36. Baron R. Mechanisms of disease: neuropathic pain–a clinical perspective. Nat Clin Pract Neurol. 2006;2(2):95–106.

    Article  PubMed  Google Scholar 

  37. Marx J. Pain research. Prolonging the agony. Science. 2004;305(5682):326–9.

    Article  PubMed  CAS  Google Scholar 

  38. Moalem G, Tracey DJ. Immune and inflammatory mechanisms in neuropathic pain. Brain Res Rev. 2006;51(2):240–64.

    Article  PubMed  CAS  Google Scholar 

  39. Ji RR et al. Central sensitization and LTP: do pain and memory share similar mechanisms? Trends Neurosci. 2003;26(12):696–705.

    Article  PubMed  CAS  Google Scholar 

  40. Ren K, Dubner R. Neuron-glia crosstalk gets serious: role in pain hypersensitivity. Curr Opin Anaesthesiol. 2008;21(5):570–9.

    Article  PubMed  Google Scholar 

  41. Yunus MB. Role of central sensitization in symptoms beyond muscle pain, and the evaluation of a patient with widespread pain. Best Pract Res Clin Rheumatol. 2007;21(3):481–97.

    Article  PubMed  Google Scholar 

  42. Woolf CJ, Mannion RJ. Neuropathic pain: aetiology, symptoms, mechanisms, and management. Lancet. 1999;353(9168):1959–64.

    Article  PubMed  CAS  Google Scholar 

  43. Kendler KS, Thornton LM, Gardner CO. Stressful life events and previous episodes in the etiology of major depression in women: an evaluation of the “kindling” hypothesis. Am J Psychiatry. 2000;157(8):1243–51.

    Article  PubMed  CAS  Google Scholar 

  44. Post RM. Kindling and sensitization as models for affective episode recurrence, cyclicity, and tolerance phenomena. Neurosci Biobehav Rev. 2007;31(6):858–73.

    Article  PubMed  Google Scholar 

  45. Miller L. Neurosensitization: A model for persistent disability in chronic pain, depression, and posttraumatic stress disorder following injury. NeuroRehabilitation. 2000;14(1):25–32.

    PubMed  Google Scholar 

  46. Dadabhoy D et al. Biology and therapy of fibromyalgia. Evidence-based biomarkers for fibromyalgia syndrome. Arthritis Res Ther. 2008;10(4):211.

    Article  PubMed  Google Scholar 

  47. Tracey I, Mantyh PW. The cerebral signature for pain perception and its modulation. Neuron. 2007;55(3):377–91.

    Article  PubMed  CAS  Google Scholar 

  48. Blackburn-Munro G, Blackburn-Munro RE. Chronic pain, chronic stress and depression: coincidence or consequence? J Neuroendocrinol. 2001;13(12):1009–23.

    Article  PubMed  CAS  Google Scholar 

  49. Schweinhardt P et al. Investigation into the neural correlates of emotional augmentation of clinical pain. Neuroimage. 2008;40(2):759–66.

    Article  PubMed  Google Scholar 

  50. Borsook D et al. Neuroimaging revolutionizes therapeutic approaches to chronic pain. Mol Pain. 2007;3:25.

    Article  PubMed  Google Scholar 

  51. Zhuo M. Cortical excitation and chronic pain. Trends Neurosci. 2008;31(4):199–207.

    Article  PubMed  CAS  Google Scholar 

  52. Apkarian AV et al. Human brain mechanisms of pain perception and regulation in health and disease. Eur J Pain. 2005;9(4):463–84.

    Article  PubMed  Google Scholar 

  53. Raison CL, Capuron L, Miller AH. Cytokines sing the blues: inflammation and the pathogenesis of depression. Trends Immunol. 2006;27(1):24–31.

    Article  PubMed  CAS  Google Scholar 

  54. Neugebauer V et al. The amygdala and persistent pain. Neuroscientist. 2004;10(3):221–34.

    Article  PubMed  Google Scholar 

  55. Apkarian AV et al. Chronic back pain is associated with decreased prefrontal and thalamic gray matter density. J Neurosci. 2004;24(46):10410–5.

    Article  PubMed  CAS  Google Scholar 

  56. Sorensen L et al. Differences in metabolites in pain-processing brain regions in patients with diabetes and painful neuropathy. Diabetes Care. 2008;31(5):980–1.

    Article  PubMed  Google Scholar 

  57. Cauda F et al. Altered resting state in diabetic neuropathic pain. PLoS ONE. 2009;4(2):e4542.

    Article  PubMed  Google Scholar 

  58. Cauda F et al. Low-frequency BOLD fluctuations demonstrate altered thalamocortical connectivity in diabetic neuropathic pain. BMC Neurosci. 2009;10:138.

    Article  PubMed  Google Scholar 

  59. Frodl T et al. Effect of hippocampal and amygdala volumes on clinical outcomes in major depression: a 3-year prospective magnetic resonance imaging study. J Psychiatry Neurosci. 2008;33(5):423–30.

    PubMed  Google Scholar 

  60. Matthews SC et al. Decreased functional coupling of the amygdala and supragenual cingulate is related to increased depression in unmedicated individuals with current major depressive disorder. J Affect Disord. 2008;111(1):13–20.

    Article  PubMed  Google Scholar 

  61. Baliki MN et al. Chronic pain and the emotional brain: specific brain activity associated with spontaneous fluctuations of intensity of chronic back pain. J Neurosci. 2006;26(47):12165–73.

    Article  PubMed  CAS  Google Scholar 

  62. Goncalves L et al. Neuropathic pain is associated with depressive behaviour and induces neuroplasticity in the amygdala of the rat. Exp Neurol. 2008;213(1):48–56.

    Article  PubMed  Google Scholar 

  63. Tsigos C, Chrousos GP. Hypothalamic-pituitary-adrenal axis, neuroendocrine factors and stress. J Psychosom Res. 2002;53(4):865–71.

    Article  PubMed  Google Scholar 

  64. Strouse TB. The relationship between cytokines and pain/depression: a review and current status. Curr Pain Headache Rep. 2007;11(2):98–103.

    Article  PubMed  Google Scholar 

  65. Rajkowska G, Miguel-Hidalgo JJ. Gliogenesis and glial pathology in depression. CNS Neurol Disord Drug Targets. 2007;6(3):219–33.

    Article  PubMed  CAS  Google Scholar 

  66. Pav M et al. Neurobiological aspects of depressive disorder and antidepressant treatment: role of glia. Physiol Res. 2008;57(2):151–64.

    PubMed  CAS  Google Scholar 

  67. McNally L, Bhagwagar Z, Hannestad J. Inflammation, glutamate, and glia in depression: a literature review. CNS Spectr. 2008;13(6):501–10.

    PubMed  Google Scholar 

  68. Tsuda M, Inoue K, Salter MW. Neuropathic pain and spinal microglia: a big problem from molecules in “small” glia. Trends Neurosci. 2005;28(2):101–7.

    Article  PubMed  CAS  Google Scholar 

  69. Zieglgansberger W, Berthele A, Tolle TR. Understanding neuropathic pain. CNS Spectr. 2005;10(4):298–308.

    PubMed  Google Scholar 

  70. Chapman CR, Tuckett RP, Song CW. Pain and stress in a systems perspective: reciprocal neural, endocrine, and immune interactions. J Pain. 2008;9(2):122–45.

    Article  PubMed  Google Scholar 

  71. Wieseler-Frank J, Maier SF, Watkins LR. Immune-to-brain communication dynamically modulates pain: physiological and pathological consequences. Brain Behav Immun. 2005;19(2):104–11.

    Article  PubMed  CAS  Google Scholar 

  72. Acee AM. Detecting and managing depression in type II diabetes: PHQ-9 is the answer! Medsurg Nurs. 2010;19(1):32–8.

    PubMed  Google Scholar 

  73. van Steenbergen-Weijenburg KM et al. Validation of the PHQ-9 as a screening instrument for depression in diabetes patients in specialized outpatient clinics. BMC Health Serv Res. 2010;10:235.

    Article  PubMed  Google Scholar 

  74. Brennan C et al. The hospital anxiety and depression scale: a diagnostic meta-analysis of case-finding ability. J Psychosom Res. 2010;69(4):371–8.

    Article  PubMed  Google Scholar 

  75. Lloyd CE, Dyer PH, Barnett AH. Prevalence of symptoms of depression and anxiety in a diabetes clinic population. Diabet Med. 2000;17(3):198–202.

    Article  PubMed  CAS  Google Scholar 

  76. Spitzer RL et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.

    Article  PubMed  Google Scholar 

  77. Lowe B et al. Validation and standardization of the Generalized Anxiety Disorder Screener (GAD-7) in the general population. Med Care. 2008;46(3):266–74.

    Article  PubMed  Google Scholar 

  78. • Reddy P et al. Identification of depression in diabetes: the efficacy of PHQ-9 and HADS-D. Br J Gen Pract. 2010; 60(575):239–45. This article offers a fair balanced review of the benefits and potential pitfalls of using PHQ-9 and HADS-D in DPNP patients.

    Article  Google Scholar 

  79. Gonzalez JS, Esbitt SA. Depression and treatment nonadherence in type 2 diabetes: assessment issues and an integrative treatment approach. Epidemiol Psichiatr Soc. 2010;19(2):110–5.

    PubMed  Google Scholar 

  80. Fortmann AL et al. Support for disease management, depression, self-care, and clinical indicators among Hispanics with type 2 diabetes in San Diego County, United States of America. Rev Panam Salud Publica. 2010;28(3):230–4.

    Article  PubMed  Google Scholar 

  81. Echeverry D et al. Effect of pharmacological treatment of depression on A1C and quality of life in low-income Hispanics and African Americans with diabetes: a randomized, double-blind, placebo-controlled trial. Diabetes Care. 2009;32(12):2156–60.

    Article  PubMed  CAS  Google Scholar 

  82. Bogner HR, de Vries HF. Integrating type 2 diabetes mellitus and depression treatment among African Americans: a randomized controlled pilot trial. Diabetes Educ. 2010;36(2):284–92.

    Article  PubMed  Google Scholar 

  83. Ell K et al. Collaborative care management of major depression among low-income, predominantly Hispanic subjects with diabetes: a randomized controlled trial. Diabetes Care. 2010;33(4):706–13.

    Article  PubMed  Google Scholar 

  84. • Ismail K et al. A randomised controlled trial of cognitive behaviour therapy and motivational interviewing for people with Type 1 diabetes mellitus with persistent sub-optimal glycaemic control: a Diabetes and Psychological Therapies (ADaPT) study. Health Technol Assess. 2010; 14(22):1–101, iii-iv. This article demosntates the importnace of nonpharmacologic interventions in diabetes.

    PubMed  CAS  Google Scholar 

  85. van Bastelaar K et al. Development and reach of a web-based cognitive behavioural therapy programme to reduce symptoms of depression and diabetes-specific distress. Patient Educ Couns. 2010.

  86. Kuritzky L. Managing diabetic peripheral neuropathic pain in primary care. J Fam Pract. 2010;59(5 Suppl):S15–22.

    PubMed  Google Scholar 

  87. Tesfaye S. Advances in the management of diabetic peripheral neuropathy. Curr Opin Support Palliat Care. 2009;3(2):136–43.

    Article  PubMed  Google Scholar 

  88. Greist JH et al. Depression and pain. J Clin Psychiatry. 2008;69(12):1970–8.

    Article  PubMed  Google Scholar 

  89. Smink BE, Egberts ACG, Lusthof KJ. The relationship between benzodiazepine use and traffic accident: a systematic litreature review. CNS Drugs. 2010;24(8):639–53.

    Article  PubMed  CAS  Google Scholar 

  90. Uzun S et al. Side effects of treatment with benzodiazepines. Psychiatr Danub. 2010;22(1):90–3.

    PubMed  Google Scholar 

  91. Skljarevski V et al. Evaluating the maintenance of effect of duloxetine in patients with diabetic peripheral neuropathic pain. Diabetes Metab Res Rev. 2009;25(7):623–31.

    Article  PubMed  CAS  Google Scholar 

  92. Rynn M et al. Efficacy and safety of duloxetine in the treatment of generalized anxiety disorder: a flexible-dose, progressive-titration, placebo-controlled trial. Depress Anxiety. 2008;25(3):182–9.

    Article  PubMed  CAS  Google Scholar 

  93. Kornstein SG et al. A randomized, double-blind study of increasing or maintaining duloxetine dose in patients without remission of major depressive disorder after initial duloxetine therapy. J Clin Psychiatry. 2008;69(9):1383–92.

    Article  PubMed  CAS  Google Scholar 

  94. Abrahamian H et al. Diabetes mellitus and co-morbid depression: treatment with milnacipran results in significant improvement of both diseases (results from the Austrian MDDM study group). Neuropsychiatr Dis Treat. 2009;5:261–6.

    Article  PubMed  CAS  Google Scholar 

  95. Lieberman DZ, Massey SH. Desvenlafaxine in major depressive disorder: an evidence-based review of its place in therapy. Core Evid. 2010;4:67–82.

    PubMed  Google Scholar 

  96. Pae CU et al. Milnacipran: beyond a role of antidepressant. Clin Neuropharmacol. 2009;32(6):355–63.

    Article  PubMed  CAS  Google Scholar 

  97. Golden RN, Nicholas L. Antidepressant efficacy of venlafaxine. Depress Anxiety. 2000;12 Suppl 1:45–9.

    Article  PubMed  Google Scholar 

  98. Di Guilmi MN et al. Pregabalin modulation of neurotransmitter release is mediated by change in intrinsic activation/inactivation properties of CaV2.1 calcium channels. J Pharmacol Exp Ther. 2010.

  99. Satosh J, Yagihashi S, Baba M, Suzuki M. Efficacy and safety of pregabalin for treating neuropathic pain associated with diabetic peripheral neuropathy: a 14 week, randomized, double blind, placebo-controlled trial. Diabet Med. 2011;28(1):109–16.

    Article  Google Scholar 

  100. Montgomery SA, Herman BK, Schweizer E. The efficacy of pregabalin and benzodiazepines in generalized anxiety disorder presenting with high levels of insomnia. Int Clin Psychopharmacology. 2009;24(4):214–22.

    Article  Google Scholar 

  101. Bryan C et al. The impact of diabetes on depression treatment outcomes. Gen Hosp Psychiatry. 2010;32(1):33–41.

    Article  PubMed  Google Scholar 

  102. Osborn CY, Kozak C, Wagner J. Theory in practice: helping providers address depression in diabetes care. J Contin Educ Health Prof. 2010;30(3):172–9.

    Article  PubMed  Google Scholar 

  103. Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Arlington, VA: APA Press; 2000.

Download references

Disclosure

Conflicts of interest: R. Jain: is on the advisory boards and speakers panels for Eli Lilly, Pfizer, Forest Pharmaceuticals, and Takeda Pharmaceutical Co.; S. Jain: none; C.L. Raison: none; V. Maletic: is on the advisory boards and speakers panels for Eli Lilly, Pfizer, Forest Pharmaceuticals, and Takeda Pharmaceutical Co.

Author information

Author notes

  1. Vladimir Maletic

    Present address: , 38 Parkway Commons Way, Greer, SC, 29650, USA

Authors and Affiliations

  1. Department of Psychiatry, Texas Tech Health Sciences Center Medical School at Permian Basin, Midland, TX, USA

    Rakesh Jain

  2. Department of Psychiatry, Texas Tech Health Sciences Center Medical School at Permian Basin, 301 North N. Street, Midland, TX, 79701, USA

    Shailesh Jain

  3. Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, 1365B Clifton Road, Room 51003, Atlanta, GA, 30322, USA

    Charles L. Raison

  4. Department of Neuropsychiatry and Behavioral Sciences, University of South Carolina School of Medicine, Columbia, SC, USA

    Vladimir Maletic

  5. 129 Circle Way, Suite 110, Lake Jackson, TX, 77566, USA

    Rakesh Jain

Authors
  1. Rakesh Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shailesh Jain
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles L. Raison
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Vladimir Maletic
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rakesh Jain.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Jain, R., Jain, S., Raison, C.L. et al. Painful Diabetic Neuropathy is More than Pain Alone: Examining the Role of Anxiety and Depression as Mediators and Complicators. Curr Diab Rep 11, 275–284 (2011). https://doi.org/10.1007/s11892-011-0202-2

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-011-0202-2

Keywords

Search

Navigation