Patients with comorbid chronic pain and greater pain severity have poorer overall diabetes self-management and more difficulty with self-care activities. "Many adults experience chronic pain, yet little is known about the consequences of such pain among individuals with diabetes," Dr. Sarah L. Krein, of the University of Michigan Medical School, Ann Arbor, and colleagues write.
In a cross-sectional analysis, the researchers examined the effects of chronic pain on diabetes self-management in 993 patients receiving treatment through the Department of Veterans Affairs.
Data were collected using a written survey. Chronic pain was defined as the presence of pain most of the time for at least 6 months during the past year. Multiple regression analysis was performed, adjusting for sociodemographic data and other health factors.
About 60% of the subjects reported chronic pain. Patients with chronic pain tended to be younger than those without chronic pain, female, more likely to be using insulin and had a higher body mass index.
A significant association was observed between chronic pain and poorer overall diabetes self-management (p = 0.002). Patients with chronic pain also had more difficulty following recommended exercise and eating plans (adjusted odds ratios 3.0 and 1.6).
"Among patients with chronic pain, overall self-management was also significantly poorer for those who indicated their pain was severe or very severe compared with those who rated their pain as mild or moderate (p = 0.003)," the researchers write. "Specifically, patients with severe pain reported more difficulty with taking diabetes medications (adjusted OR = 2.0) and with exercise (2.5)."
Based on the findings, Dr. Krein’s group suggests that "comorbid chronic pain may be a major limiting factor in the performance of certain self-care behaviors and thereby reinforces the need to proactively address such potential competing demands" to improve self-management in diabetics.
Diabetes Care 2005;28:65-70.
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