The role of physical activity and psychological coping strategies in the management of painful diabetic neuropathy – A systematic review of the literature

BackgroundDiabetes is rising in prevalence; painful diabetic neuropathy (PDN) is one complication of diabetes. PDN is primarily managed with medication but analgesic failure is common and people remain in pain and distress. It is unclear whether pain management strategies are appropriate for PDN.ObjectivesTo establish the effectiveness of physical activity and psychological coping strategies for PDN.DesignSystematic literature review.Data sourcesTen online databases.Eligibility criteria (participants and interventions)Controlled trials reporting specific results for PDN, investigating, (a) physical activity or (b) psychological coping strategies and measuring pain as an outcome. The search was restricted to published research with no restriction on language or date of publication.Study appraisal methodsMethodological quality and risk of bias assessed with Cochrane collaboration and NICE checklist for randomised controlled trials.ResultsOf 1306 titles identified, four studies met the inclusion criteria. Two trials investigated physical activity and two investigated psychological coping interventions. Studies showed pain measures improved or did not worsen compared to controls, but methodological quality was moderate and results need cautious interpretation.LimitationsThe studies were of small sample size and used a diverse range of outcome measures. There is high risk of bias from lack of blinding and attrition at follow up.Conclusions and implications of key findingsThe research literature in this area is sparse and inconsistent, despite the pressing clinical challenge of PDN. Firm conclusions cannot be drawn from the studies included. Further high quality research is required to match treatment provision to patient requirements.