Pain affects millions of people with diabetes. 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.
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-care 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 Christine Sullivan, founder of Real Help for Chronic Pain, 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.