Diabetic Foot Study Group: Diabetes, pain, and the consequences

What is the diabetic patient’s experience of pain with regards to diabetic foot ulcers, and why is this important to clinicians? These questions were answered, and important issues raised, at the Diabetic Foot Study Group’s 10th Scientific Meeting, held between 28–30 September 2012 in Berlin-Potsdam, Germany. Stimulating presentations were delivered by Dr Clifford Richardson of the University of Manchester and Professor Dominic Upton of the University of Worcester, in this symposium, sponsored by Mölnlycke Health Care. The symposium was chaired by Dr Kristien Van Acker, a diabetologist specialising in diabetic foot syndrome. Due to the high incidence of diabetic neuropathy in patients with diabetic foot ulcers (Pirart, 1977; Tesfaye et al, 2010; Boulton and Vileikyte, 2011), it is often assumed that patients do not experience pain. However, as Dr Richardson asserted at the symposium, neuropathy can involve both numbness and pain, which may even occur together in some patients, giving a feeling of “painful numbness”. Pain is in fact commonly experienced by people with diabetes, particularly on walking or standing (Ribu et al, 2006), and it is reported to be a “hidden burden” (Bradbury and Price, 2011a; 2011b). People with painful diabetic neuropathy describe pain as “aching”, “throbbing”, and “tender” sensations (Bradbury and Price, 2011c). The management of painful diabetic neuropathy requires a person-centred approach, taking comorbidities into account (Tesafaye et al, 2011). Given that pain can impact on a patient’s experience of stress, anxiety, and quality of life, in addition to its effect on wound healing (Solowiej et al, 2009), it is important that clinicians acknowledge the pain experience and seek to reduce pain, particularly during dressing change and treatment. The patient experience of pain was expertly addressed at the symposium, with Dr Richardson first highlighting the physiological and biopsychosocial aspects of pain, before Professor Upton presented the findings of a recent study into patients’ experience of pain and how perceptions of this pain differ between patients and clinicians. Finally, a reflective discussion session followed, focussing on the realities of differing perceptions about the pain experience, and the implications for assessment and practice for those involved in treating patients with diabetic foot ulcers.