Common Meanings of Living with Diabetic Peripheral Neuropathic Pain from the Perspective of Patients

  • Zehra Gok MetinEmail author


Contemporary pain medicine is necessary to explain pain and to help in its treatment; yet, preference for biomedical explanation of pain in the field has meant that attention to the personal experience of pain and to the meanings of pain experience remain a blind spot in knowledge. Thus, the pain literature includes limited information about the common meanings of living with diabetic peripheral neuropathic pain (DPNP) from the perspective of patients. The purpose of this chapter is to describe some of the common meanings of pain in patients with DPNP, as currently reported in the literature, how these meanings interact with other common factors in pain experience, including specific negative emotions or moods (depression, anxiety, anger), or the psychosocial context surrounding pain, and to describe available evidence on the effectiveness of cognitive behavioral therapy (CBT) for patients with DPNP. Further quantitative, qualitative or mixed methods research is needed to more fully understand common experiences of pain in patients with DPNP, and the common meanings ascribed to these experiences.

Clinical Implications: Pain in patients with DPNP involves a range of threatening pain sensations, including sensations with burning, shooting, tingling, or cramping qualities, and additional more cognitive meanings linked to persistent pain, including a sense that pain disrupts daily life in an intrusive way. Pain affects many aspects of daily experience that are meaningful to patients with DPNP; some describe ongoing physical difficulties, others describe work-related problems or challenges in sexual intimacy. Given the heavy personal burden that DPNP imposes on patients and the considerable challenge of managing the condition pharmacologically, clinical use of non-pharmacological therapies such as CBT for painful diabetic neuropathy might be warranted in individual patients.


Diabetic peripheral neuropathic pain Interpretative Phenomenological Analysis (IPA) Lived experiences Meaning of pain Pain experience 



I am grateful to Dr. Simon van Rysewyk for comments and edits of an earlier draft of this chapter.


Informed consent was obtained from all individual participants included in the study.


  1. 1.
    Tesfaye S, Selvarajah D. Advances in the epidemiology, pathogenesis and management of diabetic peripheral neuropathy. Diabetes Metab Res Rev. 2012;28:8–14.PubMedCrossRefGoogle Scholar
  2. 2.
    Gordois A, Scuffham P, Shearer A, Oglesby A, Tobian JA. The health care costs of diabetic peripheral neuropathy in the US. Diabetes Care. 2003;26(6):1790–5.PubMedCrossRefGoogle Scholar
  3. 3.
    Davies M, Brophy S, Williams R, Taylor A. The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes. Diabetes Care. 2006;29(7):1518–22.PubMedCrossRefGoogle Scholar
  4. 4.
    Tesfaye S, Boulton AJ, Dyck PJ, Freeman R, Horowitz M, Kempler P, et al. Diabetic neuropathies: update on definitions, diagnostic criteria, estimation of severity, and treatments. Diabetes Care. 2010;33(10):2285–93.PubMedPubMedCentralCrossRefGoogle Scholar
  5. 5.
    Tesfaye S. Recent advances in the management of diabetic symmetrical polyneuropathy. J Diabetes Investig. 2010;2:33–42.CrossRefGoogle Scholar
  6. 6.
    Merskey H. Classification of chronic pain. Description of chronic pain syndromes and definitions of pain terms. Seattle: IASP Press; 1994. 213 p.Google Scholar
  7. 7.
    McDermott AM, Toelle TR, Rowbotham DJ, Schaefer CP, Dukes EM. The burden of neuropathic pain: results from a cross-sectional survey. Eur J Pain. 2006;10(2):127–35.PubMedCrossRefGoogle Scholar
  8. 8.
    Quattrini C, Tesfaye S. Understanding the impact of painful diabetic neuropathy. Diabetes Metab Res Rev. 2003;19(S1):S2–8.PubMedCrossRefGoogle Scholar
  9. 9.
    Gore M, Brandenburg NA, Dukes E, Hoffman DL, Tai K-S, Stacey B. Pain severity in diabetic peripheral neuropathy is associated with patient functioning, symptom levels of anxiety and depression, and sleep. J Pain Symptom Manag. 2005;30(4):374–85.CrossRefGoogle Scholar
  10. 10.
    Boulton AJ, Kirsner RS, Vileikyte L. Neuropathic diabetic foot ulcers. N Engl J Med. 2004;351(1):48–55.PubMedCrossRefGoogle Scholar
  11. 11.
    Health NIo. National institute of diabetes and digestive and kidney diseases. Diabetes in America. 2nd ed. NIH Publication; 1995(95–1468).Google Scholar
  12. 12.
    Dyck PJB, Norell JE, Dyck PJ. Microvasculitis and ischemia in diabetic lumbosacral radiculoplexus neuropathy. Neurology. 1999;53(9):2113–21.PubMedCrossRefGoogle Scholar
  13. 13.
    Poncelet AN. Diabetic polyneuropathy. Risk factors, patterns of presentation, diagnosis, and treatment. Geriatrics (Basel, Switzerland) 2003;58(6):16–8, 24–5, 30.Google Scholar
  14. 14.
    Benbow S, Wallymahmed M, MacFarlane I. Diabetic peripheral neuropathy and quality of life. QJM. 1998;91(11):733–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Melton L III, Dyck P. Diabetic polyneuropathy. In: Dyck PJ, Thomas PK, editors. Diabetic Neuropathy. 2nd ed. Philadelphia: WB Saunders; 1999. p. 255–78.Google Scholar
  16. 16.
    Campbell JN, Meyer RA. Mechanisms of neuropathic pain. Neuron. 2006;52(1):77–92.PubMedPubMedCentralCrossRefGoogle Scholar
  17. 17.
    Boureau F, Doubrere J, Luu M. Study of verbal description in neuropathic pain. Pain. 1990;42(2):145–52.PubMedCrossRefGoogle Scholar
  18. 18.
    Thomas PK. Classification of the diabetic neuropathies. In: Gries FA, Cameron NE, Low PA, Ziegler D, editors. Textbook of diabetic neuropathy. Stuttgart: Thieme; 2003. p. 175–7.Google Scholar
  19. 19.
    Price DD, Harkins SW. The affective-motivational dimension of pain A two-stage model. APS J. 1992;1(4):229–39.CrossRefGoogle Scholar
  20. 20.
    Cassell EJ. The phenomenon of suffering and its relationship to pain. In: Handbook of phenomenology and medicine. Dordrecht: Springer; 2001. p. 371–90.CrossRefGoogle Scholar
  21. 21.
    Crowe M, Whitehead L, Seaton P, Jordan J, Mccall C, Maskill V, et al. Qualitative meta-synthesis: the experience of chronic pain across conditions. J Adv Nurs. 2017;73(5):1004–16.PubMedPubMedCentralCrossRefGoogle Scholar
  22. 22.
    Ojala T, Häkkinen A, Karppinen J, Sipilä K, Suutama T, Piirainen A. Chronic pain affects the whole person – a phenomenological study. Disabil Rehabil. 2015;37(4):363–71.PubMedCrossRefGoogle Scholar
  23. 23.
    Breivik H, Collett B, Ventafridda V, Cohen R, Gallacher D. Survey of chronic pain in Europe: prevalence, impact on daily life, and treatment. Eur J Pain. 2006;10(4):287–333.PubMedPubMedCentralCrossRefGoogle Scholar
  24. 24.
    Elliott AM, Smith BH, Penny KI, Smith WC, Chambers WA. The epidemiology of chronic pain in the community. Lancet. 1999;354(9186):1248–52.PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Gureje O, Von Korff M, Simon GE, Gater R. Persistent pain and well-being: a world health organization study in primary care. JAMA. 1998;280(2):147–51.PubMedCrossRefGoogle Scholar
  26. 26.
    Jensen MP, Chodroff MJ, Dworkin RH. The impact of neuropathic pain on health-related quality of life review and implications. Neurology. 2007;68(15):1178–82.PubMedCrossRefGoogle Scholar
  27. 27.
    Meyer-Rosberg K, Burckhardt CS, Huizar K, Kvarnström A, Nordfors LO, Kristofferson A. A comparison of the SF-36 and Nottingham health profile in patients with chronic neuropathic pain. Eur J Pain. 2001;5(4):391–403.PubMedCrossRefGoogle Scholar
  28. 28.
    Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain. 2002;18(6):350–4.PubMedCrossRefGoogle Scholar
  29. 29.
    Zelman DC, Brandenburg NA, Gore M. Sleep impairment in patients with painful diabetic peripheral neuropathy. Clin J Pain. 2006;22(8):681–5.PubMedCrossRefGoogle Scholar
  30. 30.
    Haythornthwaite JA, Benrud-Larson LM. Psychological aspects of neuropathic pain. Clin J Pain. 2000;16(2 Suppl):S101–5.PubMedCrossRefGoogle Scholar
  31. 31.
    Meyer-Rosberg K, Kvarnström A, Kinnman E, Gordh T, Nordfors LO, Kristofferson A. Peripheral neuropathic pain—a multidimensional burden for patients. Eur J Pain. 2001;5(4):379–89.PubMedCrossRefGoogle Scholar
  32. 32.
    Watkins PJ. Pain and diabetic neuropathy. Br Med J (Clin Res Ed). 1984;288(6412):168–9.CrossRefGoogle Scholar
  33. 33.
    Novella SP, Inzucchi SE, Goldstein JM. The frequency of undiagnosed diabetes and impaired glucose tolerance in patients with idiopathic sensory neuropathy. Muscle Nerve. 2001;24(9):1229–31.PubMedCrossRefGoogle Scholar
  34. 34.
    Watkins P, Edmonds M. Clinical features of diabetic neuropathy. Textbook of diabetes. 1997. p. 1–20.Google Scholar
  35. 35.
    Tesfaye S, Watt J, Benbow SJ, Pang KA, Miles J, MacFarlane IA. Electrical spinal-cord stimulation for painful diabetic peripheral neuropathy. Lancet. 1996;348(9043):1698–701.PubMedCrossRefGoogle Scholar
  36. 36.
    Robinson N, Yateman N, Protopapa L, Bush L. Employment problems and diabetes. Diabet Med. 1990;7(1):16–22.PubMedCrossRefGoogle Scholar
  37. 37.
    Finnerup NB, Sindrup SH, Jensen TS. The evidence for pharmacological treatment of neuropathic pain. Pain. 2010;150(3):573–81.PubMedCrossRefGoogle Scholar
  38. 38.
    Rijken P, Dekker J, Dekker E, Lankhorst G, Bakker K, Dooren J, et al. Clinical and functional correlates of foot pain in diabetic patients. Disabil Rehabil. 1998;20(9):330–6.PubMedCrossRefGoogle Scholar
  39. 39.
    Brod M, Pohlman B, Blum SI, Ramasamy A, Carson R. Burden of illness of diabetic peripheral neuropathic pain: a qualitative study. Patient. 2015;8(4):339–48.PubMedCrossRefGoogle Scholar
  40. 40.
    Gok Metin Z, Arslan IE. Diabetic peripheral neuropathic pain from the perspective of turkish patients: a qualitative study. J Transcult Nurs. 2018;29(6):514–22.PubMedCrossRefGoogle Scholar
  41. 41.
    Smith JA. Qualitative psychology: a practical guide to research methods. London: Sage; 2015. 312 p.Google Scholar
  42. 42.
    Dezutter J, Luyckx K, Wachholtz A. Meaning in life in chronic pain patients over time: associations with pain experience and psychological well-being. J Behav Med. 2015;38(2):384–96.PubMedPubMedCentralCrossRefGoogle Scholar
  43. 43.
    Vlaeyen JW, Morley S, Crombez G. The experimental analysis of the interruptive, interfering, and identity-distorting effects of chronic pain. Behav Res Ther. 2016;86:23–34.PubMedCrossRefGoogle Scholar
  44. 44.
    Harden N, Cohen M. Unmet needs in the management of neuropathic pain. J Pain Symptom Manag. 2003;25(5):S12–S7.CrossRefGoogle Scholar
  45. 45.
    Jensen TS, Gottrup H, Sindrup SH, Bach FW. The clinical picture of neuropathic pain. Eur J Pharmacol. 2001;429(1–3):1–11.PubMedCrossRefGoogle Scholar
  46. 46.
    Tölle T, Xu X, Sadosky AB. Painful diabetic neuropathy: a cross-sectional survey of health state impairment and treatment patterns. J Diabetes Complicat. 2006;20(1):26–33.PubMedCrossRefGoogle Scholar
  47. 47.
    Gatchel RJ. Comorbidity of chronic pain and mental health disorders: the biopsychosocial perspective. Am Psychol. 2004;59(8):795.PubMedCrossRefGoogle Scholar
  48. 48.
    Turk DC, Swanson KS, Tunks ER. Psychological approaches in the treatment of chronic pain patients—when pills, scalpels, and needles are not enough. Can J Psychiatr. 2008;53(4):213–23.CrossRefGoogle Scholar
  49. 49.
    Scascighini L, Sprott H. Chronic nonmalignant pain: a challenge for patients and clinicians. Nat Rev Rheumatol. 2008;4(2):74–81.CrossRefGoogle Scholar
  50. 50.
    Daniel HC, Narewska J, Serpell M, Hoggart B, Johnson R, Rice AS. Comparison of psychological and physical function in neuropathic pain and nociceptive pain: implications for cognitive behavioral pain management programs. Eur J Pain. 2008;12(6):731–41.PubMedCrossRefGoogle Scholar
  51. 51.
    Morley S, Eccleston C, Williams A. Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache. Pain. 1999;80(1–2):1–13.PubMedCrossRefGoogle Scholar
  52. 52.
    Morley S. Process and change in cognitive behaviour therapy for chronic pain. Pain. 2004;109(3):205–6.PubMedCrossRefGoogle Scholar
  53. 53.
    Daniel HC, Van der Merwe JD. Cognitive behavioral approaches and neuropathic pain. Handb Clin Neurol. 2006;81:855–68.PubMedCrossRefGoogle Scholar
  54. 54.
    Vitiello MV, Rybarczyk B, Von Korff M, Stepanski EJ. Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis. J Clin Sleep Med. 2009;5(04):355–62.PubMedPubMedCentralGoogle Scholar
  55. 55.
    Glombiewski JA, Hartwich-Tersek J, Rief W. Two psychological interventions are effective in severely disabled, chronic back pain patients: a randomised controlled trial. Int J Behav Med. 2010;17(2):97–107.PubMedCrossRefGoogle Scholar
  56. 56.
    Holroyd KA, O'donnell FJ, Stensland M, Lipchik GL, Cordingley GE, Carlson BW. Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: a randomized controlled trial. JAMA. 2001;285(17):2208–15.PubMedPubMedCentralCrossRefGoogle Scholar
  57. 57.
    Hoffman BM, Papas RK, Chatkoff DK, Kerns RD. Meta-analysis of psychological interventions for chronic low back pain. Health Psychol. 2007;26(1):1–9.PubMedCrossRefGoogle Scholar
  58. 58.
    Crombez G, Vlaeyen JW, Heuts PH, Lysens R. Pain-related fear is more disabling than pain itself: evidence on the role of pain-related fear in chronic back pain disability. Pain. 1999;80(1–2):329–39.PubMedCrossRefGoogle Scholar
  59. 59.
    Lamé IE, Peters ML, Vlaeyen JW, Kleef M, Patijn J. Quality of life in chronic pain is more associated with beliefs about pain, than with pain intensity. Eur J Pain. 2005;9(1):15–24.PubMedCrossRefGoogle Scholar
  60. 60.
    de Jong JR, Vlaeyen JW, Onghena P, Goossens ME, Geilen M, Mulder H. Fear of movement/(re) injury in chronic low back pain: education or exposure in vivo as mediator to fear reduction? Clin J Pain. 2005;21(1):9–17.PubMedCrossRefGoogle Scholar
  61. 61.
    O’Connor AB, Dworkin RH. Treatment of neuropathic pain: an overview of recent guidelines. Am J Med. 2009;122(10):S22–32.PubMedCrossRefGoogle Scholar
  62. 62.
    Quilici S, Chancellor J, Löthgren M, Simon D, Said G, Le TK, et al. Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain. BMC Neurol. 2009;9(1):6.PubMedPubMedCentralCrossRefGoogle Scholar
  63. 63.
    McCracken LM, Turk DC. Behavioral and cognitive-behavioral treatment for chronic pain: outcome, predictors of outcome, and treatment process. Spine. 2002;27(22):2564–73.PubMedCrossRefGoogle Scholar
  64. 64.
    Eccleston C, Crombez G. Advancing psychological therapies for chronic pain. F1000Res. 2017;6:461.PubMedPubMedCentralCrossRefGoogle Scholar
  65. 65.
    Vlaeyen JW, De Jong JR, Onghena P, Kerckhoffs-Hanssen M, Kole-Snijders AM. Can pain-related fear be reduced? The application of cognitive-behavioral exposure in vivo. Pain Res Manag. 2002;7(3):144–53.PubMedCrossRefGoogle Scholar
  66. 66.
    Butler AC, Chapman JE, Forman EM, Beck AT. The empirical status of cognitive-behavioral therapy: a review of meta-analyses. Clin Psychol Rev. 2006;26(1):17–31.PubMedCrossRefGoogle Scholar
  67. 67.
    Evans S, Fishman B. Pain management training: a cognitive-behavioral approach to treating HIV-related peripheral neuropathy. J Cogn Psychother. 1997;11(4):251–61.CrossRefGoogle Scholar
  68. 68.
    Evans S, Fishman B, Spielman L, Haley A. Randomized trial of cognitive behavior therapy versus supportive psychotherapy for HIV-related peripheral neuropathic pain. Psychosomatics. 2003;44(1):44–50.PubMedCrossRefGoogle Scholar
  69. 69.
    Daut RL, Cleeland CS, Flanery RC. Development of the Wisconsin brief pain questionnaire to assess pain in cancer and other diseases. Pain. 1983;17(2):197–210.PubMedCrossRefGoogle Scholar
  70. 70.
    Otis JD, Sanderson K, Hardway C, Pincus M, Tun C, Soumekh S. A randomized controlled pilot study of a cognitive-behavioral therapy approach for painful diabetic peripheral neuropathy. J Pain. 2013;14(5):475–82.PubMedCrossRefGoogle Scholar
  71. 71.
    Otis J. Managing chronic pain: a cognitive-behavioral therapy approach. New York: Oxford university press; 2007. 83 p.Google Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Faculty of Nursing, Medical Nursing DepartmentHacettepe UniversityAltindagTurkey

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