Improve Painful Diabetic Neuropathy with Mindfulness
By John M. de Castro, Ph.D.
“mindfulness specifically can also potentially improve quality of life for patients with neuropathy. . . Research indicates that in addition to improving pain, mindfulness also addresses the psychological consequences of chronic pain, including depression symptoms.” – Foundation for Peripheral Neuropathy
Diabetes can lead to a very painful condition known as diabetic neuropathy. The high blood glucose levels associated with diabetes can damage nerves and result in a burning pain and numbness, particularly from the legs and feet. It affects the majority of long-term diabetes patients. This is not only painful but is also disruptive to the normal life functions of these patients. There are no cures, but diabetic neuropathy can be prevented by blood glucose control in the diabetic patient with a rigorous program of measured diet and exercise. Treatment for diabetic neuropathy usually involves pain management with drugs.
Mindfulness practices have been shown to help with pain management and with quality of life in diabetes patients. and has been shown to improve the symptoms of diabetic neuropathy. A therapeutic technique that contains mindfulness training is Acceptance and Commitment Therapy (ACT). It is a mindfulness-based psychotherapy technique that is employs many of the techniques of Cognitive Behavioral Therapy (CBT) and focuses on the individual’s thoughts, feelings, and behavior and how they interact to impact their psychological and physical well-being. It then works to change thinking to alter the interaction and produce greater life satisfaction. ACT employs mindfulness practices to increase awareness and develop an attitude of acceptance and compassion in the presence of painful thoughts and feelings. ACT teaches individuals to “just notice”, accept and embrace private experiences and focus on behavioral responses that produce more desirable outcomes.
It is important, then, to study the effectiveness of Acceptance and Commitment Therapy (ACT) for reducing pain and improving quality of life in patients with diabetic neuropathy. In today’s Research News article “The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial.” (See summary below or view the full text of the study at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7376796/) Taheri and colleagues recruited patients diagnosed with diabetic peripheral neuropathy, aged 35 to 65 years, and randomly assigned them to either receive 8 sessions of ACT or to a no-treatment control condition. They were measured before and after training and 3 months later for sensory pain, psychological pain, and chronic pain acceptance.
They found that in comparison to the baseline and the no-treatment control group the patients who received Acceptance and Commitment Therapy (ACT) had significant decreases in pain and significant increases in pain acceptance. These benefits of ACT were still significant at the 3-month follow up. So ACT were appears to produce significant and lasting improvements in diabetic peripheral neuropathy pain and its acceptance.
The trial did not have an active control group. So, the design is not the strongest and may be open to confounding. In addition, Acceptance and Commitment Therapy (ACT) is a complex therapy that includes mindfulness and Cognitive Behavioral Therapy (CBT), along with other therapeutic components. So, it cannot be determined which of these components or which combination of components were responsible for the effects. Previous research has shown that mindfulness training improves the symptoms of diabetic neuropathy. So, it is reasonable to conclude that the mindfulness component of ACT is effective. Hence, the study suggests that ACT is a safe, effective, and lasting treatment for diabetic peripheral neuropathy pain.
So, improve painful diabetic neuropathy with mindfulness.
“by activating and reinforcing some areas of the brain used in pain processing, meditation has the overall effect of helping to reduce pain intensity in patients. Other theories on how meditation affects pain, including that it decreases stress, which in turn decreases pain.” – Foundation for Peripheral Neuropathy
CMCS – Center for Mindfulness and Contemplative Studies
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Taheri, A. A., Foroughi, A. A., Mohammadian, Y., Ahmadi, S. M., Heshmati, K., Hezarkhani, L. A., & Parvizifard, A. A. (2020). The Effectiveness of Acceptance and Commitment Therapy on Pain Acceptance and Pain Perception in Patients with Painful Diabetic Neuropathy: A Randomized Controlled Trial. Diabetes therapy : research, treatment and education of diabetes and related disorders, 11(8), 1695–1708. https://doi.org/10.1007/s13300-020-00851-9
Neuropathic pain is a complex phenomenon in patients with diabetes. These patients have many problems, such as psychological problems, high-level pain perception, and pain acceptance. This study aimed to evaluate the effectiveness of acceptance and commitment therapy on pain acceptance and pain perception in patients with painful diabetic neuropathy.
This study was performed according to the clinical trial method. The sample size was 50 participants. In this study, participants were divided into interventional and control groups. According to the diagnosis of neurologists, all participants received conventional medications to manage neuropathic pain. The intervention group received acceptance and commitment therapy for eight sessions. The results in the three phases of pre-test, post-test, and follow-up were evaluated. After completing the study, to comply with ethical standards, the control group received psycho-education. The tools used were the McGill Pain Questionnaire (MPQ) and the Chronic Pain Acceptance Questionnaire (CPAQ). Statistical analysis includes mean, standard deviation, and repeated-measures (ANOVA) conducted by SPSS software version 22.
The results demonstrated that in the post-test and follow-up phases, acceptance and commitment therapy could improve pain acceptance and reduce pain perception in the intervention group compared to the control group (P < 0.01).
The results indicated that acceptance and commitment therapy could be used as a psychological intervention besides pharmacotherapy to improve pain acceptance and reduce pain perception in patients with painful diabetic neuropathy.
Key Summary Points
|Why carry out this study?|
|Patients with painful diabetic neuropathy endure severe and excruciating pain that adversely affects their function. According to Melzack theory, one of the most important factors in pain perception is psychological factors.|
|Before this study, no clinical trial study had been performed to measure the effectiveness of psychological therapy in reducing the severity of pain perception in patients with painful diabetic neuropathy.|
|The main purpose of this study was to investigate the effectiveness of acceptance and commitment therapy (ACT) therapy on improving pain acceptance and subsequently reduction of pain perception.|
|What was learned from the study?|
|The results showed that compared to the control group, the interventional group had significant improvement in pain acceptance and also a major reduction in pain perception in the post-test phase. The same results were observed after a 3-month follow-up.|