In its early stages, diabetes is stealthy: People with the disease may look healthy and be highly functional even as high glucose (sugar) levels are irreparably damaging their bodies.
Longer-term complications can be devastating and sometimes deadly: an increased risk of heart disease and stroke, kidney failure, impotence and blindness. Another common complication, diabetic peripheral neuropathy – damage to the nerves of the arms, hands, legs and feet – means that many people with diabetes live with severe chronic pain, sometimes over decades.
Diabetic peripheral neuropathy increases the risk for foot ulcers and amputation, as minor cuts, sores or blisters may go unnoticed due to nerve damage and may become infected. Even in the absence of wounds, however, the chronic pain can be severely disabling, elevating the risk of depression, which may then intensify the pain. “People with diabetic peripheral neuropathy, report burning, shooting pain – the sensation of walking on hot rocks,” says Dr. Nathan. The touch of bedclothes may be excruciating, making sleep difficult.
A research team led by Dr. Howard Nathan hopes to offer a source of relief. The AWARE study, funded by the Canadian Diabetes Association, is a randomized, controlled clinical trial that will document and measure the effects of mindfulness-based stress reduction on pain, as well as cortisol production and blood glucose.
A pain physician at The Ottawa Hospital (TOH) Pain Clinic, Dr. Nathan and his wife, Dr. Katalin Nathan, a clinical psychologist, offer a nine-week stress reduction program. Participants in the program report significant improvement in their experience of pain.
“Pain is not simply a sensation, like heat or cold. It is more like a fire alarm, telling us to save ourselves,” Dr. Nathan explains. “The severity of pain doesn’t necessarily increase with the severity of injury. Pain triggers a ‘fight or flight’ or stress response, and the greater the stress response, the greater the patient distress. While this reaction to acute pain helps us survive, in chronic pain it can add to discomfort and disability.”
While this is the first study to assess the effects of mindfulness-based stress reduction on diabetic peripheral neuropathy, earlier mindfulness research suggests that increased relaxation and impulse control may translate into better blood glucose control.
The study will also measure the effect of stress reduction on the production of cortisol, a stress hormone. When elevated for too long, stress can contribute to anxiety, depression, digestive problems, heart disease, sleep problems, weight gain and memory and concentration problems.
Even the most effective prescription drugs available, taken optimally, usually only reduce the experience of chronic pain by about 30 per cent, says Dr. Nathan.
The AWARE research team hopes to provide evidence to the medical community that mindfulness-based stress reduction has important benefits and should be made available to patients with painful diabetic peripheral neuropathy.
“It is about changing the way the central nervous system processes pain,” he stresses. “When people practice diligently they learn to feel safe, even in the presence of the pain, which then becomes much more tolerable.”
For more information on diabetic peripheral neuropathy, screening and treatment, click here.