Psychological aspects of diabetic peripheral neuropathy

Despite a proliferation of psychosocial and behavioral studies in diabetes, complications, including diabetic peripheral neuropathy (DPN), have to dat e been largely neglected. The few reports that have assessed the effects of complications on patients' well-being, physical functioning, and quality o f life (QoL) rarely addressed neuropathy in isolation. When DPN was address ed, a number of problems existed: first, the neuropathy itself was poorly d efined; second, studies predominantly used generic approaches and rarely of fered any clinically meaningful data on the impact of DPN on psychosocial f unctioning; and third, the investigators tended to focus on extreme manifes tations of DPN such as severe pain, foot ulcers, and amputations, whereas t he majority of neuropathic patients do not fall into these categories. Unti l recently, research into the psychosocial variables that might influence a dherence or nonadherence to preventive foot care was not driven by any inte grated theory and, therefore, lacked explanatory power as to how behavioral decisions were made, There is nom some evidence of progress in this area. A new generation of measures, that is, condition-specific measures, are in development, such as NeuroQoL, a neuropathy-specific measure. Current resea rch that is guided by the Illness Perception Approach appears promising in explaining adherence or nonadherence to preventive foot care. Newly emergin g patient-centered, neuropathy-focused, theoretically based approaches to a dherence behaviors and QoL should increase clinicians' understanding as to how diabetic patients experience and deal with their neuropathy. This resea rch should improve our ability to empower patients to manage their neuropat hy more efficiently, ultimately leading to better physical and psychosocial outcomes.