Jump to ContentJump to Main Navigation
Show Summary Details
More options …

Scandinavian Journal of Pain

Official Journal of the Scandinavian Association for the Study of Pain

Editor-in-Chief: Breivik, Harald


CiteScore 2018: 0.85

SCImago Journal Rank (SJR) 2018: 0.494
Source Normalized Impact per Paper (SNIP) 2018: 0.427

Online
ISSN
1877-8879
See all formats and pricing
More options …
Volume 19, Issue 3

Issues

The effect of exercise therapy combined with psychological therapy on physical activity and quality of life in patients with painful diabetic neuropathy: a systematic review

Charlotte C.M. van Laake-Geelen
  • Corresponding author
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Rob J.E.M. Smeets
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • CIR Revalidatie, Eindhoven, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Suzan P.A.B. Quadflieg
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jos Kleijnen
  • Department of Family Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Jeanine A. Verbunt
  • Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands
  • Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2019-05-21 | DOI: https://doi.org/10.1515/sjpain-2019-0001

Abstract

Background and aims

Approximately 25% of patients with diabetes mellitus type 2 (DMII) develop painful diabetic neuropathy (PDN). PDN is known to affect both mental and physical wellbeing, resulting in anxiety, depression, low quality of life and physical disability. Pharmacological treatment of PDN aims at pain relief and is often ineffective and/or has many side effects. Rehabilitation treatment modalities that are designed to help the patient deal with PDN related complaints, are mostly focussed on either physical (e.g. exercise therapy) or psychological aspects (e.g. cognitive behavioural therapy, CBT). There is emerging evidence that PDN can be approached from a biopsychosocial perspective, in which physical and psychosocial aspects are integrated. From this biopsychosocial approach it is plausible that integrated treatment modalities such as acceptance commitment therapy (ACT) or exposure in vivo (EXP) could be effective in patients with PDN. The objective of this review was to provide an overview of the current evidence on the effects of rehabilitation treatments that combine exercise therapies with psychological therapies in order to improve physical activity (PA) and quality of life (QoL) in patients with PDN.

Methods

Systematic review of the current literature. EMBASE, MEDLINE, Medline In-Process citations and e-Pubs ahead-of-print, Pedro, Web of Science, PsycINFO, CENTRAL, PubMed and Google Scholar were searched. All studies on interventions combining exercise therapy with psychological interventions in patients with PDN, aged >18 years, were included. Outcome measures were PA, QoL.

Results

The search resulted in 1603 records after removing duplicates. After screening on titles and abstracts, 100 records remained. From these, not one study reported on interventions that combined exercise therapy with psychological interventions. Through a secondary hand search, a total of three reviews were identified that described a total of five studies regarding either physical or psychological interventions in patients with PDN. These studies reported moderate effects of (1) mindfulness meditation on QoL, (2) CBT on pain severity, (3) mindfulness-based stress reduction intervention on function, health-related QoL, pain catastrophizing and depression, (4) aerobic exercise on QoL and (5) Tai Chi on glucose control, balance, neuropathic symptoms, and some dimensions of QoL in patients with PDN. All studies were of a moderate quality, and results should be interpreted with caution.

Conclusions

Based on increasing knowledge in the domain of chronic pain, it could be assumed that integrated rehabilitation treatments for patients with PDN are beneficial. There is no literature to support this and more research should be done on integrated biopsychosocial interventions in patients with PDN.

Implications

This empty review highlights the importance that more research should be done on integrated biopsychosocial interventions in patients with PDN. Currently, our research group is performing a study on the effects of EXP treatment in patients with PDN.

This article offers supplementary material which is provided at the end of the article.

Keywords: painful diabetic neuropathy; review; rehabilitation intervention; exercise; psychological coping; quality of life

References

  • [1]

    Jude EB, Schaper N. Treating painful diabetic polyneuropathy. BMJ 2007;335:57.CrossrefPubMedGoogle Scholar

  • [2]

    Tesfaye S, Vileikyte L, Rayman G, Sindrup SH, Perkins BA, Baconja M, Vinik AI, Boulton AJ. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev 2011;27:629–38.CrossrefPubMedGoogle Scholar

  • [3]

    Boulton AJ, Kirsner RS, Vileikyte L. Neuropathic diabetic foot ulcers. N Engl J Med 2004;351:48–55.PubMedCrossrefGoogle Scholar

  • [4]

    Ziegler D. Treatment of diabetic neuropathy and neuropathic pain: how far have we come? Diabetes Care 2008;31(Suppl. 2):S255–61.PubMedGoogle Scholar

  • [5]

    Rosenberg CJ, Watson JC. Treatment of painful diabetic peripheral neuropathy. Prosthet Orthot Int 2015;39:17–28.PubMedCrossrefGoogle Scholar

  • [6]

    Cakici N, Fakkel TM, van Neck JW, Verhagen AP, Coert JH. Systematic review of treatments for diabetic peripheral neuropathy. Diabet Med 2016;33:1466–76.PubMedCrossrefGoogle Scholar

  • [7]

    Schmader KE. Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy. Clin J Pain 2002;18:350–4.PubMedCrossrefGoogle Scholar

  • [8]

    Peltier A, Goutman SA, Callaghan BC. Painful diabetic neuropathy. BMJ 2014;348:g1799.PubMedCrossrefGoogle Scholar

  • [9]

    Lalli P, Chan A, Garven A, Midha N, Chan C, Brady S, Block E, Hu B, Toth C. Increased gait variability in diabetes mellitus patients with neuropathic pain. J Diabetes Complications 2013;27:248–54.CrossrefPubMedGoogle Scholar

  • [10]

    van Sloten TT, Savelberg HH, Duimel-Peeters IG, Meijer K, Henry RM, Stehouwer CD, Schaper NC. Peripheral neuropathy, decreased muscle strength and obesity are strongly associated with walking in persons with type 2 diabetes without manifest mobility limitations. Diabetes Res Clin Pract 2011;91:32–9.CrossrefPubMedGoogle Scholar

  • [11]

    van Sloten TT, Savelberg HH, Duimel-Peeters IG, Meijer K, Henry RM, Stehouwer CD, Schaper NC. Peripheral neuropathy, decreased muscle strength and obesity are strongly associated with walking in persons with type 2 diabetes without manifest mobility limitations. Diabetes Res Clin Pract 2011;91:32–9.CrossrefPubMedGoogle Scholar

  • [12]

    Geelen CC, Smeets R, Schmitz S, van den Bergh JP, Goossens M, Verbunt JA. Anxiety affects disability and quality of life in patients with painful diabetic neuropathy. Eur J Pain 2017;21:1632–41.CrossrefPubMedGoogle Scholar

  • [13]

    Kanera IM, van Laake-Geelen CCM, Ruijgrok JM, Goossens MEJB, de Jong JR, Verbunt JA, Geerts M, Smeets RJEM, Kindermans HPJ. Living with painful diabetic neuropathy: insights from focus groups into fears and coping strategies. Psychol Health 2019;34:84–105.CrossrefPubMedGoogle Scholar

  • [14]

    daCosta DiBonaventura M, Cappelleri JC, Joshi AV. A longitudinal assessment of painful diabetic peripheral neuropathy on health status, productivity, and health care utilization and cost. Pain Med 2011;12:118–26.CrossrefPubMedGoogle Scholar

  • [15]

    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;29:1518–22.CrossrefPubMedGoogle Scholar

  • [16]

    Geerts M, Bours G, de Wit R, Landewé S, van Haarlem A, Schaper N. Prevalence and impact of pain in diabetic neuropathy. Eur Diab Nursing 2009;6:58–64.CrossrefGoogle Scholar

  • [17]

    Vileikyte L, Rubin RR, Leventhal H. Psychological aspects of diabetic neuropathic foot complications: an overview. Diabetes Metab Res Rev 2004;20(S1):S13–8.PubMedCrossrefGoogle Scholar

  • [18]

    Gonzalez JS, Vileikyte L, Ulbrecht JS, Rubin RR, Garrow AP, Delgado C, Cavanagh PR, Boulton AJ, Peyrot M. Depression predicts first but not recurrent diabetic foot ulcers. Diabetologia 2010;53:2241–8.CrossrefPubMedGoogle Scholar

  • [19]

    Jain R, Jain S, Raison CL, Maletic V. Painful diabetic neuropathy is more than pain alone: examining the role of anxiety and depression as mediators and complicators. Curr Diab Rep 2011;11:275–84.CrossrefPubMedGoogle Scholar

  • [20]

    Selvarajah D, Cash T, Sankar A, Thomas L, Davies J, Cachia E, Gandhi R, Wilkinson ID, Wilkinson N, Emery CJ, Tesfaye S. The contributors of emotional distress in painful diabetic neuropathy. Diab Vasc Dis Res 2014;11:218–25.CrossrefPubMedGoogle Scholar

  • [21]

    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 Manage 2005;30:374–85.PubMedCrossrefGoogle Scholar

  • [22]

    Geelen CC, Kindermans HP, van den Bergh JP, Verbunt JA. Perceived physical activity decline as a mediator in the relationship between pain catastrophizing, disability, and quality of life in patients with painful diabetic neuropathy. Pain Practice 2017;17:320–8.CrossrefGoogle Scholar

  • [23]

    Colberg SR, Sigal RJ, Fernhall B, Regensteiner JG, Blissmer BJ, Rubin RR, Chasan-Taber L, Albright AL, Braun B. Exercise and type 2 diabetes: the American College of Sports Medicine and the American Diabetes Association: joint position statement executive summary. Diabetes Care 2010;33:2692–6.CrossrefPubMedGoogle Scholar

  • [24]

    Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, Sharma NK, Wright DE. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications 2012;26:424–9.PubMedCrossrefGoogle Scholar

  • [25]

    Kluding PM, Pasnoor M, Singh R, Jernigan S, Farmer K, Rucker J, Sharma NK, Wright DE. The effect of exercise on neuropathic symptoms, nerve function, and cutaneous innervation in people with diabetic peripheral neuropathy. J Diabetes Complications 2012;26:424–9.PubMedCrossrefGoogle Scholar

  • [26]

    Thomas DE, Elliott EJ, Naughton GA. Exercise for type 2 diabetes mellitus. Cochrane Database Syst Rev 2006: CD002968.PubMedGoogle Scholar

  • [27]

    Dixit S, Maiya A, Shastry B. Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Qual Life Res 2014;23:1629–40.PubMedCrossrefGoogle Scholar

  • [28]

    Praet SF, van Rooij ES, Wijtvliet A, Boonman-de Winter LJ, Enneking T, Kuipers H, Stehouwer CD, van Loon LJ. Brisk walking compared with an individualised medical fitness programme for patients with type 2 diabetes: a randomised controlled trial. Diabetologia 2008;51:736–46.CrossrefPubMedGoogle Scholar

  • [29]

    Melai T, Schaper NC, Ijzerman TH, de Lange TL, Willems PJ, Lima Passos V, Lieverse AG, Meijer K, Savelberg HH. Lower leg muscle strengthening does not redistribute plantar load in diabetic polyneuropathy: a randomised controlled trial. J Foot Ankle Res 2013;6:41.CrossrefPubMedGoogle Scholar

  • [30]

    Geerts M, Landewe-Cleuren SA, Kars M, Vrijhoef HJ, Schaper NC. Effective pharmacological treatment of painful diabetic neuropathy by nurse practitioners: results of an algorithm-based experience. Pain Med 2012;13:1324–33.PubMedCrossrefGoogle Scholar

  • [31]

    Brazeau AS, Rabasa-Lhoret R, Strychar I, Mircescu H. Barriers to physical activity among patients with type 1 diabetes. Diabetes Care 2008;31:2108–9.CrossrefPubMedGoogle Scholar

  • [32]

    Vlaeyen JW, Kole-Snijders AM, Boeren RG, van Eek H. Fear of movement/(re)injury in chronic low back pain and its relation to behavioral performance. Pain 1995;62:363–72.CrossrefGoogle Scholar

  • [33]

    Leeuw M, Goossens ME, Linton SJ, Crombez G, Boersma K, Vlaeyen JW. The fear-avoidance model of musculoskeletal pain: current state of scientific evidence. J Behav Med 2007;30:77–94.CrossrefPubMedGoogle Scholar

  • [34]

    Verbunt JA, Seelen HA, Vlaeyen JW, van de Heijden GJ, Heuts PH, Pons K, Knottnerus JA. Disuse and deconditioning in chronic low back pain: concepts and hypotheses on contributing mechanisms. Eur J Pain 2003;7:9–21.PubMedCrossrefGoogle Scholar

  • [35]

    Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJ, Ostelo RW, Guzman J, van Tulder MW. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane Database Syst Rev 2014:Cd000963. doi: 10.1002/14651858.CD000963.pub3.PubMedGoogle Scholar

  • [36]

    Sterne JA, Hernan MA, Reeves BC, Savovic J, Berkman ND, Viswanathan M, Henry D, Altman DG, Ansari MT, Boutron I, Carpenter JR, Chan AW, Churchill R, Deeks JJ, Hrobjartsson A, Kirkham J, Juni P, Loke YK, Pigott TD, Ramsay CR, et al. ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions. BMJ 2016;355:i4919.PubMedGoogle Scholar

  • [37]

    Dixit S, Maiya A, Shastry B. Effect of aerobic exercise on quality of life in population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, randomized controlled trial. Qual Life Res 2014;23:1629–40.PubMedCrossrefGoogle Scholar

  • [38]

    Dixit S, Maiya AG, Shastry BA. Effect of aerobic exercise on peripheral nerve functions of population with diabetic peripheral neuropathy in type 2 diabetes: a single blind, parallel group randomized controlled trial. J Diabetes Complications 2014;28:332–9.CrossrefPubMedGoogle Scholar

  • [39]

    Ahn S, Song R. Effects of Tai Chi Exercise on glucose control, neuropathy scores, balance, and quality of life in patients with type 2 diabetes and neuropathy. J Altern Complement Med (New York, NY) 2012;18:1172–8.CrossrefGoogle Scholar

  • [40]

    Teixeira E. The effect of mindfulness meditation on painful diabetic peripheral neuropathy in adults older than 50 years. Holist Nurs Pract 2010;24:277–83.CrossrefPubMedGoogle Scholar

  • [41]

    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;14:475–82.CrossrefPubMedGoogle Scholar

  • [42]

    Nathan HJ, Poulin P, Wozny D, Taljaard M, Smyth C, Gilron I, Sorisky A, Lochnan H, Shergill Y. Randomized trial of the effect of mindfulness-based stress reduction on pain-related disability, pain intensity, health-related quality of life, and A1C in patients with painful diabetic peripheral neuropathy. Clin Diabetes 2017;35:294–304.CrossrefPubMedGoogle Scholar

  • [43]

    Davies B, Cramp F, Gauntlett-Gilbert J, Wynick D, McCabe CS. The role of physical activity and psychological coping strategies in the management of painful diabetic neuropathy – a systematic review of the literature. Physiotherapy (United Kingdom) 2015;101:319–26.Google Scholar

  • [44]

    Castelnuovo G, Giusti EM, Manzoni GM, Saviola D, Gatti A, Gabrielli S, Lacerenza M, Pietrabissa G, Cattivelli R, Spatola CA, Corti S, Novelli M, Villa V, Cottini A, Lai C, Pagnini F, Castelli L, Tavola M, Torta R, Arreghini M, et al. Psychological considerations in the assessment and treatment of pain in neurorehabilitation and psychological factors predictive of therapeutic response: Evidence and recommendations from the Italian Consensus Conference on Pain in Neurorehabilitation. Front Psychol 2016;7:468.PubMedGoogle Scholar

  • [45]

    D’Amato C, Morganti R, Greco C, Di Gennaro F, Cacciotti L, Longo S, Mataluni G, Lauro D, Marfia GA, Spallone V. Diabetic peripheral neuropathic pain is a stronger predictor of depression than other diabetic complications and comorbidities. Diab Vasc Dis Res 2016;13:418–28.PubMedCrossrefGoogle Scholar

  • [46]

    Gore M, Brandenburg NA, 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;30:374–85.PubMedCrossrefGoogle Scholar

  • [47]

    Benbow SJ, Wallymahmed ME, Macfarlane IA. Diabetic peripheral neuropathy and quality of life. QJM 1998;91:733–7.CrossrefPubMedGoogle Scholar

  • [48]

    Vlaeyen J, Morley S, Linton SJ, Boersma K, de Jong J. Pain-related fear: exposure based treatment for chronic pain. Seattle, USA: IASP Press, 2012:196Google Scholar

  • [49]

    de Jong JR, Vangronsveld K, Peters ML, Goossens ME, Onghena P, Bulte I, Vlaeyen JW. Reduction of pain-related fear and disability in post-traumatic neck pain: a replicated single-case experimental study of exposure in vivo. J Pain 2008;9:1123–34.PubMedCrossrefGoogle Scholar

  • [50]

    den Hollander M, Goossens M, de Jong J, Ruijgrok J, Oosterhof J, Onghena P, Smeets R, Vlaeyen JW. Expose or protect? A randomized controlled trial of exposure in vivo vs pain-contingent treatment as usual in patients with complex regional pain syndrome type 1. Pain 2016;157:2318–29.CrossrefPubMedGoogle Scholar

  • [51]

    Leeuw M, Goossens ME, van Breukelen GJ, de Jong JR, Heuts PH, Smeets RJ, Koke AJ, Vlaeyen JW. Exposure in vivo versus operant graded activity in chronic low back pain patients: results of a randomized controlled trial. Pain 2008;138:192–207.CrossrefPubMedGoogle Scholar

  • [52]

    Meulders A, Vlaeyen JW. Reduction of fear of movement-related pain and pain-related anxiety: an associative learning approach using a voluntary movement paradigm. Pain 2012;153:1504–13.PubMedCrossrefGoogle Scholar

  • [53]

    Vlaeyen JW, de Jong J, Leeuw M, Crombez G. Fear reduction in chronic pain: graded exposure in vivo with behavioral experiments. Understanding and treating fear of pain. Oxford, UK: Oxford University Press, 2004:313–43.Google Scholar

  • [54]

    de Jong JR, Vlaeyen JW, Onghena P, Cuypers C, den Hollander M, Ruijgrok J. Reduction of pain-related fear in complex regional pain syndrome type I: the application of graded exposure in vivo. Pain 2005;116:264–75.CrossrefPubMedGoogle Scholar

  • [55]

    Vlaeyen JW, de Jong J, Geilen M, Heuts PH, van Breukelen G. The treatment of fear of movement/(re) injury in chronic low back pain: further evidence on the effectiveness of exposure in vivo. Clin J Pain 2002;18:251–61.CrossrefGoogle Scholar

  • [56]

    Hayes SC, Strosahl KD, Wilson KG. Acceptance and commitment therapy: the process and practice of mindful change. New York, USA: Guilford Press, 2011.Google Scholar

  • [57]

    McCracken LM, Vowles KE. Acceptance and commitment therapy and mindfulness for chronic pain: model, process, and progress. Am Psychol 2014;69:178–87.CrossrefPubMedGoogle Scholar

  • [58]

    Crombez G, Eccleston C, Van Damme S, Vlaeyen J, Karoly P. Fear-avoidance model of chronic pain: the next generation. Clin J Pain 2012;28:475–83.PubMedCrossrefGoogle Scholar

About the article

Corresponding author: Charlotte C.M. van Laake-Geelen, MD, Department of Rehabilitation Medicine, Research School CAPHRI, Maastricht University, Maastricht, The Netherlands; and Adelante Centre of Expertise in Rehabilitation and Audiology, P.O. Box 88, 6430 AB Hoensbroek, The Netherlands, Phone: + 31 45 528 28 28


Received: 2019-01-03

Revised: 2019-04-10

Accepted: 2019-04-15

Published Online: 2019-05-21

Published in Print: 2019-07-26


Authors’ statements

Research funding: This work was partially supported by a grant from the Dutch Diabetes Foundation.

Conflict of interest: None of the authors have any financial or other relationship that might lead to a conflict of interest.

Informed consent: Not applicable.

Ethical approval: Not applicable.


Citation Information: Scandinavian Journal of Pain, Volume 19, Issue 3, Pages 433–439, ISSN (Online) 1877-8879, ISSN (Print) 1877-8860, DOI: https://doi.org/10.1515/sjpain-2019-0001.

Export Citation

©2019 Scandinavian Association for the Study of Pain. Published by Walter de Gruyter GmbH, Berlin/Boston. All rights reserved..Get Permission

Supplementary Article Materials

Comments (0)

Please log in or register to comment.
Log in