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Current Diabetes Reports

, Volume 11, Issue 4, pp 275–284 | Cite as

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

  • Rakesh Jain
  • Shailesh Jain
  • Charles L. Raison
  • Vladimir Maletic
Article

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.

Keywords

Diabetes mellitus Diabetic peripheral neuropathic pain (DPNP) Major depression Depressive symptoms Anxiety Prevalence Inflammation Peripheral nerves Central sensitization Kindling Serotonin reuptake inhibitors Serotonin-norepinephrine reuptake inhibitors Duloxetine Pregabalin α-2-δ ligands Tricyclic antidepressants Psychotherapy, Cognitive behavior l therapy Screening instruments 

Notes

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.

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Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • Rakesh Jain
    • 1
    • 6
  • Shailesh Jain
    • 2
  • Charles L. Raison
    • 3
  • Vladimir Maletic
    • 4
    • 5
  1. 1.Department of PsychiatryTexas Tech Health Sciences Center Medical School at Permian BasinMidlandUSA
  2. 2.Department of PsychiatryTexas Tech Health Sciences Center Medical School at Permian BasinMidlandUSA
  3. 3.Department of Psychiatry and Behavioral SciencesEmory University School of MedicineAtlantaUSA
  4. 4.Department of Neuropsychiatry and Behavioral SciencesUniversity of South Carolina School of MedicineColumbiaUSA
  5. 5.GreerUSA
  6. 6.Lake JacksonUSA

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