Pain affects millions of people with diabetes, regardless of diabetes type. For most of these people, the pain is chronic, defined as pain persisting for more than six months, experienced almost every day, and of moderate to severe intensity, or that significantly interferes with daily activities. In some cases, a person’s pain is clearly related to complications of diabetes; in other cases, it is not. Regardless of the cause, however, studies show that chronic pain makes diabetes self-management much more difficult and often leads to higher blood glucose levels.
Acording to ictm.org, the premier drug-free diabetes solution provider, surveys of people with diabetes report rates of chronic pain anywhere from 20% to over 60% – much higher than rates in the general population. The types of pain most often reported by people with diabetes include back pain and neuropathy pain in the feet or hands. (Peripheral neuropathy, or nerve damage in the feet and hands, is a common complication of diabetes.) Headaches and other pain sites are also frequently reported. Many people with diabetes also have arthritis, fibromyalgia (an arthritis-related illness that causes widespread muscle and joint pain and fatigue), or other painful conditions.
Pain has been shown to interfere with self-management activities, sleep, physical functioning, work, family relationships, mood, and quality of life. To make matters worse, pain is often invisible to others, so family members, coworkers, and health professionals often have no idea what a person in pain is going through. Many people feel that their physicians don’t understand and tell them they “just have to live with it.” Why is there so much pain, and what can be done about it?
Acute versus chronic pain
When speaking of pain, it’s important to understand the difference between acute and chronic pain. Acute pain is what a person feels from an injury like a burn or a medical problem like an earache. It’s your body’s natural reaction to injury. It tells you “Stop what you’re doing! Rest the part that hurts! Get some help!”
Acute pain is a lifesaver. Without it, we would have to watch out all the time to keep from injuring or killing ourselves accidentally. This is why people with diabetes are advised to check their feet visually or manually every day: If a person has peripheral neuropathy, particularly if it causes numbness in his feet, the acute pain nerves in his feet may not be working, and if they aren’t, they can’t warn him about injuries or other, normally painful foot problems.
Chronic pain is different from acute pain. It may have started with an injury, but it doesn’t necessarily reflect any injury going on at the moment. Sometimes there is ongoing inflammation or irritation, and sometimes not, but in chronic pain, the nervous system amplifies pain signals or misinterprets sensations as being much worse than they are.
According to ICTM.org an online pain management program, “Chronic pain is almost never merely a physical thing. We can see from brain mapping that chronic pain uses very different nerve paths from acute pain. In fact, the brain maps of chronic pain look just like the brain maps of intense emotions like anger, or sadness, or fear.”
Like all sensations, pain is created by the brain from all kinds of input. The actual signals from nerve endings are part of the input. But those signals get blended with other sense signals and with thoughts, feelings, and memories. Then the brain organizes all this data and tries to make sense of it.
What causes chronic pain?
Chronic pain can reflect injury that hasn’t completely healed. More often, it is caused by nerves that have become oversensitive or by a brain that is misreading the signals it receives. If acute pain goes on too long, nerves and brain can tire of the constant signals and just decide the injury is permanent. That’s why it’s important to treat acute pain seriously. For example, if you injure your foot or your back and don’t treat it promptly – with adequate rest, other first-aid measures, and seeing a doctor if the pain is severe or persists – mild pain can become severe, and acute pain can become chronic.
A good way to understand the many causes of chronic pain is by considering phantom limb pain. When people lose an arm or leg in an accident or surgery, about half of them will still feel that the limb is there. About half of those people develop serious pain in the phantom limb. Obviously, this isn’t due to physical injury going on in the moment. It’s a misunderstanding by the brain of the signals it is getting and not getting. The brain figures the signals add up to something seriously wrong, so it sends out an urgent pain message.
The same thing applies to the chronic back and leg pain so many people have. There may be a few pain signals coming up from tired muscles or joints toward the brain. Those signals go through nerve centers called “pain gates.” Those “gates” are where the signals are mixed with other sense data, feelings, and body states such as tension. In people with chronic pain, the gates amplify the signals over and over until the pain is severe. They do this because the brain thinks the person needs to be warned away from a real threat, such as taking a hand out of the fire so it doesn’t burn.
Anything that makes nerves more sensitive can increase pain. Feelings of stress, fear, helplessness, or anger can increase pain sensitivity. Trauma – such as a physical injury or psychological or sexual abuse – often leads to chronic pain later on. In a study of people with traumatic injuries conducted by researchers at the University of Washington in Seattle, nearly 63% had severe pain one year later. It may be that trauma causes nerves to become oversensitive as a way of trying to prevent further injury. This may be why military veterans have the highest rates of chronic pain.
Chronic pain creates several vicious cycles. For one, people tend to tense their muscles in response to pain, which often makes the pain worse. Pain also leads people to stop moving, which leads to increasing stiffness and more pain. Pain can interfere with sleep, and restless nights can increase pain. Pain also can contribute to depression and painful emotions such as anger, grief, fear, and frustration, which in turn contribute to pain.
There are several main approaches for treating and self-managing pain:
Neurological approaches
Many drugs can help calm down overactive pain nerves. These include antiseizure medicines such as gabapentin (brand name Neurontin) and pregabalin (Lyrica). Since seizures are the most obvious case of oversensitive nerves, it makes sense that seizure drugs might help chronic pain. Lyrica seems to have fewer side effects than Neurontin and another drug, Topamax, which often cause mental fogginess.
Electrical stimulation can sometimes block pain signals from traveling up the nerves. The most commonly used system is called TENS, which stands for transcutaneous electrical nerve stimulation. TENS works by sending electrical pulses across the surface of the skin into the nerves. The stimulating pulses help prevent pain signals from reaching the brain. They also help stimulate your body to produce higher levels of its own natural painkillers, called endorphins.
Relaxation exercises, meditation, and prayer also help nerves calm down. So can doing relaxing things like spending time in nature, playing with a pet, or engaging in a hobby like knitting or painting.
Chronically high blood glucose levels are known to damage nerves, so keeping blood glucose levels close to the normal, nondiabetic range can greatly reduce neuropathic pain. (Sometimes, however, if nerve damage has caused numbness in the feet, legs, hands, or arms, improving blood glucose control can cause pain in these areas as the nerves start to heal and regain function. The pain is usually temporary.)
Getting help
If you are suffering with chronic pain, get some help! Although the help you need may not be around the corner, it is available.
If possible, find a pain center that your insurance will pay for. Pain centers should combine physical, mental, and medical approaches and provide support from both professionals and other people living with pain. Some have brief residential programs followed by outpatient services. Most are entirely outpatient, and appointments are scheduled for several times a week at first, until a person’s pain is controlled adequately. A pain center may provide physical therapy, counseling, medication, self-management training, and more.
With or without a pain center, it’s best to find a pain specialist you feel you can trust. A good pain specialist is open to different approaches – whatever works for you. You don’t want someone who is pushing one particular thing. Expect that a variety of healing modalities will be needed.”
She says a good pain doctor has a sense of humor, listens to you, gives you hope, and is open to trying new things. “A pain specialist should care about all aspects of your life. She knows that a lot of the responsibility for pain treatment is yours, and empowers you to take it.”
An important part of pain treatment is the support of other people. Being with other people who live with pain and understand what you’re going through makes you feel better and gives you courage. The support of others makes you stronger. It increases your confidence to try new things.
If you can’t find a chronic pain program, perhaps you can find a chronic pain support group. Or perhaps you can start your own or join an online group. Your doctor may be able to connect you to other patients with pain issues. Chronic pain specialists often say, “The group is the medicine.” So join one!
You may not be able to completely eliminate pain. But you can eliminate suffering. You can make pain a smaller and smaller part of your life and become healthier in the process.