A Randomized Controlled Pilot Study of a Cognitive-Behavioral Therapy Approach for Painful Diabetic Peripheral Neuropathy

Published:February 28, 2013DOI:


      The purpose of the present pilot study was to assess the efficacy of cognitive-behavioral therapy (CBT) for painful diabetic peripheral neuropathy. This was a randomized, treatment as usual (TAU), controlled, nonblinded intervention pilot study with a 4-month follow-up conducted in a VA medical center. It was hypothesized that participants who received CBT, as compared to those who received TAU, would report significant decreases on self-report measures of pain severity, interference, and depressive symptoms from pretreatment to 4-month follow-up. Participants meeting inclusion criteria were randomly assigned to 1 of the study conditions. Of the 20 eligible participants, 12 were randomized to CBT and 8 were randomized to TAU. Participants randomized to CBT showed significant decreases on measures of pain severity (B = −.54) and pain interference (B = −.77) from pretreatment to 4-month follow-up. There were no significant changes in the TAU participants' scores on measures of pain severity (B = .00) or pain interference (B = −.09). Neither CBT nor TAU participants showed significant changes in their levels of depressive symptoms from pretreatment to 4-month follow-up. CBT may be an effective treatment approach for reducing pain severity and interference associated with painful diabetic peripheral neuropathy.


      The results of this study suggest that engaging patients in CBT for painful diabetic peripheral neuropathy may provide them the skills to become more active and experience less pain.

      Key words

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to The Journal of Pain
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Amsberg S.
        • Anderbro T.
        • Wredling R.
        • Lisspers J.
        • Lins P.E.
        • Adamson U.
        • Johansson U.B.
        A cognitive behavior therapy-based intervention among poorly controlled adult type 1 diabetes patients–a randomized controlled trial.
        Patient Educ Couns. 2009; 77: 72-80
        • Atkins D.C.
        Using multilevel models to analyze couple and family treatment data: Basic and advanced issues.
        J Fam Psychol. 2005; 19: 98-110
        • Beck A.T.
        • Steer R.A.
        • Garbin M.G.
        Psychometric properties of the Beck Depression Inventory: Twenty-five years of evaluation.
        Clin Psychol Rev. 1988; 8: 77-100
        • Bryk A.S.
        • Raudenbush S.W.
        Application of hierarchical linear models to assessing change.
        Psychol Bull. 1987; 101: 147-158
        • daCosta DiBonaventura M.
        • Cappelleri J.C.
        • Joshi A.V.
        A longitudinal assessment of painful diabetic peripheral neuropathy on health status, productivity, and health care utilization and cost.
        Pain Med. 2010; 12: 118-126
        • Davies M.
        • Brophy S.
        • Williams R.
        • Taylor A.
        The prevalence, severity, and impact of painful diabetic peripheral neuropathy in type 2 diabetes.
        Diabetes Care. 2006; 29: 1518-1522
        • Doth A.H.
        • Hansson P.T.
        • Jensen M.P.
        • Taylor R.S.
        The burden of neuropathic pain: A systematic review and meta-analysis of health utilities.
        Pain. 2010; 149: 338-344
        • Fisher K.
        Assessing clinically meaningful change following a programme for managing chronic pain.
        Clin Rehabil. 2008; 22: 252-259
        • Glombiewski J.A.
        • Hartwich-Tersek J.
        • Rief W.
        Two psychological interventions are effective in severely disabled, chronic back pain patients: A randomised controlled trial.
        Int J Behav Med. 2010; 17: 97-107
        • Hoffman B.M.
        • Papas R.K.
        • Chatkoff D.K.
        • Kerns R.D.
        Meta-analysis of psychological interventions for chronic low back pain.
        Health Psychol. 2007; 26: 1-9
        • Holroyd K.A.
        • O'Donnell F.J.
        • Stensland M.
        • Lipchik G.L.
        • Cordingley G.E.
        • Carlson B.W.
        Management of chronic tension-type headache with tricyclic antidepressant medication, stress management therapy, and their combination: A randomized controlled trial.
        JAMA. 2001; 285: 2208-2215
        • Heutink M.
        • Post M.W.
        • Bongers-Janssen H.M.
        • Dijkstra C.A.
        • Snoek G.J.
        • Spijkerman D.C.
        • Lindeman E.
        The CONECSI trial: Results of a randomized controlled trial of a multidisciplinary cognitive behavioral program for coping with chronic neuropathic pain after spinal cord injury.
        Pain. 2012; 153: 120-128
        • Kerns R.D.
        • Turk D.C.
        • Rudy T.E.
        The West Haven-Yale Multidimensional Pain Inventory (WHYMPI).
        Pain. 1985; 23: 345-356
        • Love A.W.
        Depression in chronic low back pain patients: Diagnostic efficiency of three self-report questionnaires.
        J Clin Psychol. 1987; 43: 84-89
        • Magnusson J.E.
        • Becker W.J.
        Migraine frequency and intensity: Relationship with disability and psychological factors.
        Headache. 2003; 43: 1049-1059
      1. Mersky H. Bogduk N. Classification of Chronic Pain: Descriptions of Chronic Pain Syndromes and Definitions of Pain Terms. IASPTask Force on Taxonomy, Seattle, WA1994
        • Moher D.
        • Hopewell S.
        • Schulz K.F.
        • Montori V.
        • Gotzsche P.C.
        • Devereaux P.J.
        • Elbourne D.
        • Egger M.
        • Altman D.G.
        CONSORT 2010 explanation and elaboration: Updated guidelines for reporting parallel group randomised trials.
        BMJ. 2010; 340: c869
        • Morley S.
        • Eccleston C.
        • Williams A.
        Systematic review and meta-analysis of randomized controlled trials of cognitive behaviour therapy and behaviour therapy for chronic pain in adults, excluding headache.
        Pain. 1999; 80: 1-13
        • O'Connor A.B.
        Neuropathic pain: Quality-of-life impact, costs and cost effectiveness of therapy.
        Pharmacoeconomics. 2009; 27: 95-112
        • Ostelo R.W.
        • Deyo R.A.
        • Stratford P.
        • Waddell G.
        • Croft P.
        • Von Korff M.
        • Bouter L.M.
        • de Vet H.C.
        Interpreting change scores for pain and functional status in low back pain: Towards international consensus regarding minimal important change.
        Spine (Phila Pa 1976). 2008; 33: 90-94
        • Otis J.D.
        Managing Chronic Pain: A cognitive-behavioral therapy approach.
        1 ed. Oxford University Press, New York, NY2007
        • Pieber K.
        • Herceg M.
        • Paternostro-Sluga T.
        Electrotherapy for the treatment of painful diabetic peripheral neuropathy: A review.
        J Rehabil Med. 2010; 42: 289-295
        • Porto F.
        • de Leeuw R.
        • Evans D.R.
        • Carlson C.R.
        • Yepes J.F.
        • Branscum A.
        • Okeson J.P.
        Differences in psychosocial functioning and sleep quality between idiopathic continuous orofacial neuropathic pain patients and chronic masticatory muscle pain patients.
        J Orofac Pain. 2011; 25: 117-124
        • Quilici S.
        • Chancellor J.
        • Lothgren M.
        • Simon D.
        • Said G.
        • Le T.K.
        • Garcia-Cebrian A.
        • Monz B.
        Meta-analysis of duloxetine vs. pregabalin and gabapentin in the treatment of diabetic peripheral neuropathic pain.
        BMC Neurol. 2009; 9: 6
        • Schmader K.E.
        Epidemiology and impact on quality of life of postherpetic neuralgia and painful diabetic neuropathy.
        Clin J Pain. 2002; 18: 350-354
        • Schulz K.F.
        • Altman D.G.
        • Moher D.
        CONSORT 2010 statement: Updated guidelines for reporting parallel group randomized trials.
        Ann Intern Med. 2010; 152: 726-732
        • Smeets R.J.
        • Beelen S.
        • Goossens M.E.
        • Schouten E.G.
        • Knottnerus J.A.
        • Vlaeyen J.W.
        Treatment expectancy and credibility are associated with the outcome of both physical and cognitive-behavioral treatment in chronic low back pain.
        Clin J Pain. 2008; 24: 305-315
        • Turner J.A.
        • Romano J.M.
        Self-report screening measures for depression in chronic pain patients.
        J Clin Psychol. 1984; 40: 909-913
        • van Bastelaar K.M.
        • Pouwer F.
        • Cuijpers P.
        • Riper H.
        • Snoek F.J.
        Web-based depression treatment for type 1 and type 2 diabetic patients: A randomized, controlled trial.
        Diabetes Care. 2011; 34: 320-325
        • Vitiello M.V.
        • Rybarczyk B.
        • Von Korff M.
        • Stepanski E.J.
        Cognitive behavioral therapy for insomnia improves sleep and decreases pain in older adults with co-morbid insomnia and osteoarthritis.
        J Clin Sleep Med. 2009; 5: 355-362
        • Watson C.P.
        The treatment of neuropathic pain: Antidepressants and opioids.
        Clin J Pain. 2000; 16: S49-S55