Behavioral Therapy Eases Pain from Diabetic Neuropathy

In the first study of its kind, researchers at Boston University School of Medicine and the Veterans Administration say that cognitive behavioral therapy (CBT) can help relieve chronic pain for people suffering from type II diabetes.

In a study published in the Journal of Pain, doctors used CBT, a psychological treatment program aimed at encouraging positive thoughts and behaviors, to see if it could benefit veterans with painful diabetic neuropathy.

“This study demonstrates that the millions of people who are experiencing pain and discomfort from type II diabetes do not need to rely solely on medication for relief,” said clinical psychologist John D. Otis, PhD, an associate professor of psychiatry at Boston University.

“The results of this study add to a growing body of literature demonstrating that cognitive behavioral therapy is an effective psychological treatment approach for chronic pain management,”


Type II diabetes is the most common form of the disease and affects more than 20 million Americans. Its onset is gradual, occurring when a person is unable to make or use insulin efficiently, resulting in high levels of sugar accumulating in the blood in a condition known as hyperglycemia.

Left untreated, hyperglycemia can develop into nerve damage, causing painful burning and stinging sensations in the hands and feet. Pain medications used to treat the disorder often have negative side effects such as headaches, dizziness and nausea.

In the small, controlled non-blinded study, 20 veterans, age 18 and older with type II diabetes and neuropathic pain, were followed for four months at the VA’s Boston Health Care System. Twelve were enrolled in a cognitive behavioral treatment program, while the remaining 8 patients were given standard treatment.

Standard treatment concentrates on keeping blood sugar levels as close to normal. This can usually be accomplished with diet, exercise, and use of appropriate medications.

Those who underwent CBT attended 11, hour-long sessions, focused on teaching them relaxation techniques and how to identify and challenge thoughts that contribute to pain. Patients were also taught how to keep active and plan enjoyable activities such as exercise, going for walks or having dinner with friends.

After four months, those who received CBT reported feeling less pain and the pain interfered less in their daily lives. Patients who received the standard treatment showed no significant changes in pain severity or pain interference.

But researchers point out that neither cognitive behavioral therapy nor treatment as usual participants showed significant changes in their levels of depression.

Nonetheless, Dr. Otis concludes that the study suggests “that engaging patients in CBT for painful diabetic peripheral neuropathy may provide them the skills to become more active and experience less pain.”

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