The Effect of Chronic Pain on Diabetes Patients’ Self-Management

  1. Sarah L. Krein, PHD, RN12,
  2. Michele Heisler, MD, MPA12,
  3. John D. Piette, PHD12,
  4. Fatima Makki, MPH1 and
  5. Eve A. Kerr, MD, MPH12
  1. 1Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
  2. 2Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan
  1. Address correspondence and reprint requests to Sarah L Krein, PhD, RN, VA HSR&D (11H), VA Ann Arbor HCS, 2215 Fuller Rd., Ann Arbor, MI 48113. E-mail: skrein{at}


OBJECTIVE—Many adults experience chronic pain, yet little is known about the consequences of such pain among individuals with diabetes. The purpose of this study was to examine whether and how chronic pain affects diabetes self-management.

RESEARCH DESIGN AND METHODS—This is a cross-sectional study of 993 patients with diabetes receiving care through the Department of Veterans Affairs (VA). Data on chronic pain, defined as pain present most of the time for 6 months or more during the past year, and diabetes self-management were collected through a written survey. Multivariable regression techniques were used to examine the association between the presence and severity of chronic pain and difficulty with diabetes self-management, adjusting for sociodemographic and other health characteristics including depression.

RESULTS—Approximately 60% of respondents reported chronic pain. Patients with chronic pain had poorer diabetes self-management overall (P = 0.002) and more difficulty following a recommended exercise plan (adjusted odds ratio [OR] 3.0 [95% CI 2.1–4.1]) and eating plan (1.6 [1.2–2.1]). Individuals with severe or very severe pain, compared with mild or moderate, reported significantly poorer diabetes self-management (P = 0.003), including greater difficulty with taking diabetes medications (2.0 [1.2–3.4]) and exercise (2.5 [1.3–5.0]).

CONCLUSIONS—Chronic pain was prevalent in this cohort of patients with diabetes. Even after controlling for general health status and depressive symptoms, chronic pain was a major limiting factor in the performance of self-care behaviors that are important for minimizing diabetes-related complications. Competing demands, such as chronic pain, should be considered when working with patients to develop effective diabetes self-care regimens.


  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

    • Accepted September 15, 2004.
    • Received June 18, 2004.
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