Diabetes and Pain: Greater Connections Need to Be Drawn

A Letter From the Doc

By David G. Armstrong, DPM, MD, PhD

Diabetic peripheral neuropathy (DPN) is a silent, sinister syndrome. About half of people with diabetes have neuropathy. Many, if not most, of them have not only the painless problem of lost sensation, which can still be dangerous, but also the painful problem of neuropathic pain.

Training for physicians has always focused on treating symptoms. What’s fascinating about diabetes and DPN is that, often, we’re treating the absence of symptoms, in the case of painless complications. In terms of pain, a large number of people are suffering from neuropathic pain but don’t know how to describe it. My work involves helping to be able to translate those things and seek out answers—not only treating the absence of pain but also translating the often ill-defined kinds of pain that are literally and figuratively ruining my patients’ lives.

The link between diabetes and chronic pain has not been adequately explored because DPN is often near the bottom of a doctor’s list of priorities to address. Clinicians are often busy dealing with so many other things in a short appointment, such as looking at the cardiovascular and metabolic problems associated with diabetes, that pain management and research can fall by the wayside.

If you diagnose DPN and involve an interdisciplinary team, the chances of a good outcome appear to be much higher. My team’s review of extensive research focused on diabetes, DPN, diabetic ulcers, and amputations found that if a person sees just two providers each year—such as a primary care doctor and a podiatrist—their risk for amputation over the next six years reduces by anywhere from about 20–80%.

The exciting thing right now is that many current and upcoming procedures and therapies to help treat DPN have good data to support them, which former treatments often lacked. The data suggest that these new options may really extend the quality and quantity of life for those living with diabetes—it’s life-affirming.

Because of initiatives like the INvisible Project, there’s more attention being given to both the silent problems and the silent suffering. Together, we can make positive noise about this to try to effect some change.

David G. Armstrong, DPM, MD, PhD, is a professor of surgery and neurological surgery at University of Southern California’s Keck School of Medicine. He is the founder and co-director of the Southwestern Academic Limb Salvage Alliance (SALSA), and the founding president of the American Limb Preservation Society (ALPS). Armstrong is the co-editor of the American Diabetes Association’s textbook, Clinical Care of the Diabetic Foot. He is an internationally recognized leader in the field of podiatric surgery, diabetic foot care, limb preservation, tissue repair, and wound healing.