CBT for Pain

If you have diabetes, chances are you’ve experienced some kind of nerve damage, or neuropathy. About 60% to 70% of people with diabetes have some form of it, and the rate is highest in people who have had diabetes for 25 years or more. High blood glucose can damage nerve fibers all over the body, but it most commonly affects the feet and legs. When it does, the condition is called diabetic peripheral neuropathy, and it can cause considerable pain.

Effective drugs exist to alleviate the pain caused by peripheral neuropathy. They include antidepressants, anticonvulsants, and opioids and opioid-like medicines. One problem with these drugs is that they can bring unwelcome side effects, such as nausea, headaches, and dizziness. For that reason, scientists have been looking for another way of treating the pain of nerve damage.

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Researchers at Boston University School of Medicine and VA Boston Healthcare System published the results of a study that investigated whether cognitive-behavioral therapy, or CBT, could help relieve pain for people with nerve pain and diabetes. CBT is a form of psychotherapy in which patients are taught to identify and challenge negative thought patterns; doing so can lead to feeling better and to positive behavioral changes. Patients also learn specific strategies for coping with their problems.

Twenty US veterans diagnosed with Type 2 diabetes participated in the study. They had all experienced nerve pain for more than three months. Twelve of them were given CBT and eight were given what the researchers called “treatment as usual,” or TAU. The CBT participants attended 11 one-hour sessions in which they learned relaxation techniques and how to challenge thoughts that contribute to pain. They were also instructed on keeping active and on participating in pleasurable activities, such as exercise, going for walks, or just going out to dinner with friends. Four months later, the veterans using CBT reported feeling less pain than those who underwent TAU. They also reported that their pain interfered less in their daily lives. Consequently, the study brought the CBT participants two benefits: more activity (which is good for health in general), and less pain.

Of course, it’s much too early to discard pain medicines for diabetic neuropathy. But the study does indicate, as the lead researcher expressed it, “that the millions of people who are experiencing pain and discomfort from Type 2 diabetes mellitus do not need to rely solely on medication for relief.” CBT, then, can be thought of as an adjunct to medicine, not a replacement for it.

Want to learn more about reducing pain with diabetes? Read “Managing Chronic Pain” and “Coping With Painful Neuropathy.”