Chronic Pain and Diabetes: Symptoms, Types, and Management
Chronic Pain
Pain is defined as “an unpleasant sensory and emotional experience associated with actual or potential tissue damage, or described in terms of such damage.” It is always subjective, and each person learns the application of the word through experiences related to injury in early life. For example, individuals with conditions like leprosy may not be able to feel pain.
Acute vs. Chronic Pain
- Acute Pain: A warning signal that something is wrong (e.g., touching a hot stove). Its aversive quality motivates action to address the issue.
- Chronic Pain: Pain that persists past the normal time of healing, often for more than six months. It is maintained by changes in the central nervous system (brain and spinal cord) and loses its threat value; hurt does not necessarily equal harm.
Two Main Types of Pain
- Nociceptive Pain (normally functioning nervous system): Arises from damage to non-neural tissue and is due to the activation of nociceptors. It has a more consistent relation to tissue injury.
- Somatic (musculoskeletal): e.g., back pain after yard work.
- Visceral: Deep, poorly localized, referred pain (e.g., abdominal pain).
- Neuropathic Pain (abnormally functioning nervous system): Arises as a direct consequence of a lesion or disease affecting the somatosensory nervous system. It can be peripheral or central and includes spontaneous and evoked pain (e.g., allodynia from cold weather). It has a less consistent relation to tissue injury.
- Central Nervous System Pain States: Spinal cord injury, stroke, multiple sclerosis.
- Peripheral Nervous System Pain States: Postherpetic neuralgia (shingles), diabetic peripheral neuropathy, phantom limb pain, drug-induced peripheral neuropathy.
Understanding Pain Perception
- Nociception: The neural process of encoding noxious stimuli (stimuli that damage or threaten to damage normal tissues).
- Nociceptor: A high-threshold sensory receptor of the peripheral nervous system (PNS).
- Pain Threshold: The minimum intensity of a stimulus that is perceived as painful.
- Pain Tolerance Level: The maximum intensity of a pain-producing stimulus that a subject is willing to accept.
- Pain Intensity: The severity of the pain, measured by the person’s reaction.
Cold Pressor Test: Used in labs to study acute pain.
Chronic Pain
Persists past the normal time of healing (often > 6 months).
Common Causes and Risk Factors
- Advancing age is associated with a higher prevalence of chronic pain (CP) and high-impact CP.
- Age-adjusted prevalence is higher among women, previously employed adults, those living in or near poverty, and rural residents.
- Age-adjusted prevalence is lower in adults with at least a bachelor’s degree.
- Risk Factors: Aging (e.g., arthritis, herpes zoster), genetic predisposition (e.g., migraine), chronic disease (e.g., cancer, heart disease, lung disease, diabetes), injury (e.g., low back pain, neck pain), surgery (e.g., nerve damage), socioeconomic factors (e.g., education, poverty, health insurance coverage).
Functional Limitations and Workplace Implications
- Functional limitations can include squeezing, migraine headaches that significantly impact activity tolerance.
- Workplace Implications:
- 26% indicate pain as an issue in employment.
- 19% had lost jobs.
- 16% changed job tasks.
- 13% changed jobs.
- 13% lost at least 16 days from work.
Treatment
Interventions, therapy, standards, surgery (doesn’t confer long-term benefits), medication, yoga.
- Self-management
- Primary care
- Specialty care
- Pain Center: Physical Rehab, Psychology therapies, pharmacological therapies, complementary & alternative approaches, interdisciplinary pain program, biopsychosocial model, psychological treatment, topical medication, opioids.
Complications Associated with Treating Chronic Pain
Lack of health coverage, education of primary care, Acetaminophen (liver issues), Cox-inhibitors (impact blood pressure, kidney disease), Opioids (addictive, cognitive difficulties, overdose, constipation, addiction).
Diabetes
Prevalence
- 1.5 million new cases in the US per year.
- 30.3 million people in the US have diabetes.
- 7.2 million people live undiagnosed with diabetes.
- Prevalence by ethnicity:
- 15.1% Native Americans
- 12.7% African Americans
- 12.1% Hispanic Americans
- 8.0% Asian Americans
- 7.4% European Americans
- Higher incidence of kidney issues among Black, Hispanic, and Asian populations.
Symptoms
Always tired, craving extra liquids, frequent urination, always hungry, unexplained weight loss, blurred vision, numbness & tingling, wounds that won’t heal, infections, sexual dysfunction.
Types of Diabetes
- Type 1: Little or no insulin production, typically diagnosed in childhood, normal BMI, not generally inherited, significant weight loss, often very sick at diagnosis.
- Type 2: Normal or increased insulin levels, insulin resistance, typically diagnosed in adults (but increasing in children), often overweight, hereditary, mildly ill.
- Gestational Diabetes: Typically ends with delivery (though not always), often results in higher birth weight (10+ lbs. typical).
Diagnosis
- Fasting Blood Glucose ≥126 mg/dl more than once, or
- Non-Fasting Blood Glucose >200 mg/dl
- Blood Glucose Levels:
- 70 – 99: Normal
- 100 – 125: Pre-Diabetes
- 126+: Diabetes
Characteristics and Risk Factors
- Type 1: Autoimmune disease.
- Type 2: The body doesn’t use insulin efficiently; linked to obesity, most prevalent in the U.S.
- Risk Factors: Lower activity levels, higher prevalence in African Americans (12.7%) and Native Americans (15.1%), obesity (30-40% more likely to break a hip).
Treatment
- Type 1: Insulin (no other treatment).
- Type 2: Oral medication, glucose monitoring (at home, doctor’s office), diet, surgery, insulin pen/pump/obi-pod (pancreas-like), exercise, dialysis, transplant, medications.
Consequences
- #1 cause of new blindness in the US.
- Diabetic nephropathy.
- More than 2x more likely to have a heart attack or stroke.
- #1 cause of non-traumatic amputation due to vascular supply issues that prevent wound healing.
Return-to-Work/Employment Considerations
- Tight control verified by a doctor, blood glucose logs, HgA1c results.
- Frequency & duration of hypo- and hyperglycemia incidents.
- Cool, dry place for medication storage.
- Flexible work schedule for someone with unstable blood sugars; job sharing.
- Time off for doctor’s appointments.
- More frequent blood glucose testing may be required, depending on the job.