Comfort and Support Improve Painful Diabetic Neuropathy, Whereas Disappointment and Frustration Deteriorate the Metabolic and Neuropathic Status Despite an Intensive Diabetes Care Program

In this small series, we report a pilot study in which diabetic patients with painful neuropathy were closely monitored weekly by a physician skilled in intensified insulin delivery with and without the addition of alternative therapies for pain. Although the literature documents that a supportive health care team can improve diabetes control over and above the impact of simple medication adjustment, there is a paucity of reports on the impact of programs that fail to meet the expectations of patients and cause disappointment and stress. We therefore want to share our experience with five patients who were recruited as part of a pilot project to study the effect of alternative therapies in the treatment of painful diabetic neuropathy (1–5), specifically sessions with a healer and acupuncture, in which the acupuncture arm inadvertently failed.

Patients with long-standing diabetes may suffer complications, including neuropathy or nerve damage. To date, there is no specific treatment for this condition, except analgesic medications (6–10). Although, the mainstay of therapy is to stabilize the glucose levels as near to normal as possible, many times the neuropathy pain is unresponsive. The purpose of this research was to evaluate the possible effects that alternative therapies may have on painful neuropathy in a population of diabetic patients requiring daily analgesia who participated in a program designed to normalize blood glucose levels.

The protocol called for three randomized groups: group 1: experimental (healing touch) plus medical intervention; group 2: acupuncture plus medical intervention; and group 3: medical intervention alone. The patients were instructed not to tell the diabetes specialist who provided the medical intervention their randomization group. The experimental group met twice weekly for an hour-long session with the healer. The healer touched one or more areas of the subjects’ body that may have included the back, head, neck, shoulders, hands, or wrists. The touch was of light intensity, and each subject was treated sequentially. Soothing music was played in the background.

The acupuncture group was originally scheduled to receive acupuncture treatments but in fact acted as a true control and received no treatment due to a scheduling conflict. Since the patients were not allowed to reveal their randomization group to the physician, it was not discovered until after the study was completed that the acupuncture group not only did not receive treatments but also were highly irritated by the scheduling conflicts that arose.

At the beginning and end of the 6-week program, all subjects were evaluated for their metabolic and neuropathy status. Glucose and metabolic status were evaluated by measuring daily blood glucose concentrations (pre- and postprandially), glycosylated hemoglobin determination, insulin dosage, blood pressure, and weight. All five patients were seen weekly, and their medications were adjusted in an attempt to improve glucose control and to decrease the number of pain pills taken. The level of pain and neurological status were documented by pain analog scales, neurological examination for sensation, vibration, and position, as well as number of pain pills taken per day.

Table 1 shows the results of the first five patients recruited into the study. Although the sample size is small, it clearly shows that the patient who was disappointed because she did not receive the promised acupuncture treatments deteriorated, as shown by the increased number of pain pills and her lack of improved glucose control despite intensive care by both the physician and health care team. In comparison, the four other patients in the medical treatment alone and those who received the treatments from the healer improved in their objective and subjective measurements of pain and metabolic control. Of note, the indicators of sensation balance improved significantly in the patients in the healing group. In addition, both of these patients had a documented decrease in number of pain pills taken per day.

Painful neuropathy is not only uncomfortable but also interferes with function and motivation to exercise and in all levels of diabetes care. Hyperglycemia is also associated with increasing pain. In a program designed to normalize blood glucose levels as part of a treatment strategy to improve painful neuropathy, alternative therapies for the treatment of pain were added. Inherent in our study design was the possibility that patients would have difficulty managing another care facility without specific guidance and support. In the case of the healing touch group, the system worked well; in the case of the acupuncture group, the system failed. When disappointment and failure are a part of the care system, it is clear that pain intensifies. It is also clear that adding a caring and soothing experience to the chore of weekly visits to a doctor to improve glucose control may increase the chances that the pain syndrome will improve. This small series does show that merely providing intensive diabetes care is not adequate in the care of diabetic patients with pain.

In conclusion, although the number of subjects who participated in this study was small, the results are very promising. Further research is indicated to evaluate the efficacy of alternative therapies for painful diabetic neuropathy. However, it is clear that when expectations are not met by the health care system, the best intentions do not result in improved care.