Kioskli K, Scott W, Winkley K, et al. Psychosocial Factors in Painful Diabetic Neuropathy: A Systematic Review of Treatment Trials and Survey Studies. Pain Med. 2019 Apr 13. pii: 5455114. doi: 10.1093/pm/pnz071. (Systematic review)

OBJECTIVE: Diabetes mellitus is associated with a number of complications that can adversely impact patients' quality of life. A common and often painful complication is painful diabetic neuropathy. The aims of this study were to systematically review and summarize evidence from studies of psychological treatments and psychosocial factors related to painful diabetic neuropathy and assess the methodological quality of these studies.

METHODS: Electronic databases, related reviews, and associated reference lists were searched. Summaries of participants' data relating to the efficacy of psychological treatments and/or to associations between psychosocial factors and outcomes in painful diabetic neuropathy were extracted from the included studies. The methodological quality of included studies was assessed using two standardized quality assessment tools.

RESULTS: From 2,921 potentially relevant titles identified, 27 studies were included in this systematic review. The evidence suggests that depression, anxiety, sleep, and quality of life are the most studied variables in relation to pain outcomes in painful diabetic neuropathy and are consistently associated with pain intensity. The magnitude of the associations ranged from small to large.

CONCLUSIONS: Research into psychosocial factors in painful diabetic neuropathy is unexpectedly limited. The available evidence is inconsistent and leaves a number of questions unanswered, particularly with respect to causal associations between variables. The evidence reviewed indicates that depression, anxiety, low quality of life, and poor sleep are associated with pain in painful diabetic neuropathy. The disproportionate lack of research into psychological treatments for painful diabetic neuropathy represents a significant opportunity for future research.

Discipline Area Score
Psychologist 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

Not very informative...

Psychologist rater

I am surprised, as apparently the study's authors are, by the paucity of research in this area. A finding of "there isn't much research" is not very helpful to practitioners, but deserves to be noted nonetheless, at least by way of encouraging practitioners to take part in studies, if possible. The correlational results are unsurprising, but tell us little about causality.

Psychologist rater

This is a very good review highlighting the limited good data available.
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