Diabetic neuropathic pain is associated with worse mental health and sleep disorders in patients with type 2 diabetes, according to study results published in Diabetes Research & Clinical Practice.
Chronic pain may cause sleep disturbances that potentially lead to reduced cognitive function. In a cross-sectional study of patients recruited from 4 health centers in Cadiz, Spain, investigators aimed to evaluate the relationship between diabetic neuropathic pain, sleep status, and cognitive function in patients with type 2 diabetes.
Clinical characteristics and comorbidity status were assessed using patient medical records and a structured questionnaire. Variables of interest included the presence of diabetic neuropathic pain, pain intensity and phenotype, mood, sleep characteristics, cognitive function, and quality of life.
Of the 130 patients (51.5% women) with diabetic neuropathy included in the study, 65 had diabetic neuropathic pain. Depression and anxiety were more prevalent in the pain group than in the group without pain (P <.001 for both). In addition, more patients without pain achieved optimal nightly sleep (7 to 8 hours) compared with those with pain (P <.01). Quality of life scores were also significantly lower in patients with pain than in those who did not have pain (P <.001).
Diabetic neuropathic pain was associated with poor sleep quality (odds ratio [OR], 1.03; 95% CI, 1.02-1.05) and previous anxiety (OR, 2.70; 95% CI, 1.05-6.99). In patients with pain, the presence of more diabetic complications was associated with older age (OR, 1.40; 95% CI, 1.12-1.66), higher pain intensity (OR, 1.51; 95% CI, 1.00-2.28), lower cognitive performance (OR, 1.25; 95% CI, 1.09-1.43), previous anxiety (OR, 10.48; 95% CI, 1.46-75.24), and insulin treatment (OR, 124.50; 95% CI, 6.64-2335.06).
More severe pain was reported in patients with superficial spontaneous pain (effect size [b]=0.18; P <.01), paroxysmal pain (b=0.26; P <.01), and paresthesia/dysesthesia (b=0.17; P =.05). Patients with depression also reported a higher pain intensity (b=0.82; P =.05).
Among patients with neuropathic pain, higher levels of sleep disturbances were associated with lower mental health global scores (b=-0.33; P <.01).
“[M]ental comorbidity and sleep disorders are factors associated, not only with the presence of [diabetic neuropathic pain], but also to a greater pain intensity, more complications and a lower quality of life in type-2 diabetic patients,” the study authors concluded. They noted that the observational nature of the study, however, prevented the identification of causal relationships.
“Early identification of mental disorders, sleep disturbances, cognitive problems and sensorial phenotypes, should be the recommended approach in type-2 diabetes mellitus patients,” recommended the researchers.
Naranjo C, Ortega-Jiménez P, Del Reguero L, Moratalla G, Failde I. Relationship between diabetic neuropathic pain and comorbidity. Their impact on pain intensity, diabetes complications and quality of life in patients with type-2 diabetes mellitus [published online May 26, 2020]. Diabetes Res Clin Pract. doi:10.1016/j.diabres.2020.108236