Chronic Pain Hampers Diabetes Self-Care

Harder to Exercise, Diet, and Take Meds With Chronic Pain

Medically Reviewed by Michael W. Smith, MD on January 14, 2005

Chronic Pain Common

Jan. 14, 2005 -- Treating pain may be a key factor in helping to get diabetes under control.

Chronic pain hounds many people with diabetes, making it harder for them to manage their condition through exercise, healthy eating, and medications, a study shows.

Sarah Krein, PhD, RN, and colleagues report the findings in the January issue of Diabetes Care. Krein works at Veterans Affairs (VA) Ann Arbor Healthcare System in Michigan.

The burden of living in pain could distract diabetes patients from doing what's necessary for their health, say the researchers. "Chronic pain may be a major limiting factor in the performance of certain self-care behaviors," they say, calling for self-care plans that take pain and other chronic conditions into account.

Nearly 1,000 diabetes patients participated in the study. Most were men in their mid-60s.

On a scale of 1-5, the participants rated how hard it was for them to take diabetes medications, exercise regularly, follow their recommended eating plan, check their blood sugar level, and examine their feet for wounds and sores.

Besides those benchmarks of diabetes self-care, the surveys also screened for depression and asked the participants to rate their overall health.

Chronic Pain Common

About 60% of participants reported chronic pain, which was described as pain that was present most of the time for six or more months during the past year. The back, hip, and knee were most commonly affected.

On average, patients said pain had disrupted their daily life for 18 out of the last 28 days. Pain medications were taken regularly or occasionally by 78%. Those with chronic pain tended to be younger, heavier, female, and insulin users.

Self-care suffered with chronic pain. Participants with chronic pain had more trouble exercising and following their recommended diets. However, they didn't have problems taking their medications or checking their feet for wounds or sores.

General health ratings were also lower for chronic pain participants. More than half said they were in fair or poor health, compared with about a third of those without chronic pain.

In addition, chronic pain was often accompanied by depression. Nearly half of the participants with chronic pain showed signs of depression. In contrast, only 20% of pain-free participants had depression symptoms.

Even after depression and other factors were considered, the link between pain and self-care still held. Taking pain medications helped, but not enough to match the level of self-care seen in pain-free participants.

Severe Pain Makes Self-Care Tougher

Almost a third of participants with chronic pain said their pain was severe or very severe during the past four weeks. They did a significantly poorer job of managing their diabetes than those with mild or moderate pain.

For instance, participants with severe chronic pain found it tough to take their diabetes medications, which wasn't a problem for people with milder pain. Exercise was also harder with severe pain.