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

Epidemiology/Health Services/Psychosocial Research

¹Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
²Department of Internal Medicine, University of Michigan Medical School, Ann Arbor, Michigan

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}umich.edu

Article Figures & Tables

Table 1—

Social, demographic, and health status characteristics of diabetic patients with and without chronic pain

	With chronic pain	Without chronic pain	P value
n	557	371
Age (years)	64 ± 10	66 ± 10	0.0001
<60	39 (216)	26 (98)	0.0001
60–70	30 (168)	34 (125)	0.26
>70	31 (173)	40 (148)	0.006
Male	96 (537/557)	99 (368/371)	0.008
White	67 (358/538)	71 (257/362)	0.16
Education, high school or greater	83 (444/538)	81 (292/361)	0.53
Annual household income, ≥$20,000	53 (275/522)	57 (196/345)	0.23
Use insulin	44 (245/556)	36 (132/368)	0.01
No. of comorbid conditions (range 0–13)*	1.3 ± 1.3 (516)	1.3 ± 1.3 (346)	0.73
0	34 (174)	33 (114)	0.81
1	29 (149)	28 (96)	0.72
≥2	37 (193)	39 (136)	0.57
Health status, fair or poor	55 (299/543)	33 (122/368)	0.0001
CES-D 10 score ≥10†	49 (267/547)	20 (72/362)	0.0001
BMI (kg/m²)	31.5 ± 6.4	29.5 ± 5.5	0.0001
Taking care of diabetes not a high priority right now (agree vs. neutral or disagree)	20 (108/547)	21 (77/369)	0.68
Amount of pain		NA
None to moderate	68 (374/548)
Severe or very severe	32 (174/458)
Use pain medication	78 (428/552)	NA

Data are means ± SD or % (n). NA, not applicable.
*
↵* Number of comorbid conditions based on medical record data and includes 13 conditions: congestive heart failure, dementia, chronic pulmonary disease, connective tissue disease, ulcer disease, hemiplegia, leukemia, lymphoma, liver disease, cancer, renal disease, peripheral vascular disease, cerebrovascular disease, and cardiovascular disease (excluding hypertension or dyslipidemia) (21).
†
↵† A score ≥10 is considered probable depression (i.e., positive screen).

Table 2—

Linear and logistic regression results of the effect of chronic pain on diabetes self-management*

	Self-management			Difficulty taking diabetes medication	Difficulty with exercise	Difficulty following eating plan	Difficulty with foot care	Difficulty with monitoring
		β-Coefficient (95% CI)	P	Difficulty taking diabetes medication	Difficulty with exercise	Difficulty following eating plan	Difficulty with foot care	Difficulty with monitoring
Chronic pain	−5.0 (−7.8 to −2.2)	0.002	1.7 (0.68–4.5)	3.0 (2.1–4.1)	1.6 (1.2–2.1)	1.2 (0.75–1.9)	1.3 (0.62–2.5)
CES-D 10 score ≥10	−6.6 (−8.9 to −4.3)	0.000	3.2 (2.1–5.0)	1.3 (0.73–2.4)	1.7 (1.2–2.4)	3.2 (1.9–5.3)	1.2 (0.84–1.8)
Health fair or poor	−3.7 (−6.2 to −1.1)	0.008	0.95 (0.39–2.3)	2.0 (1.3–3.0)	1.2 (0.88–1.7)	0.93 (0.56–1.5)	1.4 (0.95–2.0)
1 comorbid condition vs. none	0.72 (−0.87 to 2.3)	0.350	0.69 (0.25–1.9)	1.4 (1.0–1.8)	1.2 (0.87–1.7)	1.1 (0.57–2.0)	0.74 (0.41–1.3)
≥2 comorbid conditions vs. none	−1.5 (−3.5 to 0.41)	0.110	1.7 (1.1–2.7)	2.0 (1.2–3.2)	1.1 (0.80–1.5)	1.7 (1.0–3.0)	0.79 (0.51–1.2)
Diabetes not a priority	−4.9 (−8.1 to −1.8)	0.004	1.8 (0.99–3.3)	1.3 (1.0–1.6)	1.8 (1.2–2.8)	1.5 (0.83–2.7)	1.7 (1.4–2.2)

Data are adjusted OR (95% CI) unless otherwise stated.
*
↵* All models were adjusted for the variables listed as well as for annual household income, education, insulin use, age, sex, race, BMI, and clustering by site.

Table 3—

Linear and logistic regression results of the effect of pain severity on diabetes self-management*

	Self-management			Difficulty taking diabetes medication	Difficulty with exercise	Difficulty following eating plan	Difficulty with foot care	Difficulty with monitoring
		β-Coefficient (95% CI)	P	Difficulty taking diabetes medication	Difficulty with exercise	Difficulty following eating plan	Difficulty with foot care	Difficulty with monitoring
Pain severe or very severe	−5.2 (−8.3 to −2.1)	0.003	2.0 (1.2–3.4)	2.5 (1.3–5.0)	1.2 (0.90–1.7)	1.8 (0.88–3.7)	1.1 (0.63–1.9)
CES-D 10 score ≥10	−7.0 (−9.5 to −4.5)	0.000	3.3 (1.5–7.3)	1.5 (0.75–2.8)	1.6 (1.2–2.2)	2.8 (1.4–5.6)	1.5 (1.0–2.1)
Health fair or poor	−2.8 (−5.1 to −0.49)	0.021	1.0 (0.39–2.8)	1.5 (0.86–2.5)	1.3 (1.0–1.6)	0.72 (0.34–1.5)	1.4 (0.99–1.9)
1 comorbid condition vs. none	1.7 (−0.62 to 4.1)	0.140	0.57 (0.17–1.9)	1.3 (0.93–1.9)	0.93 (0.56–1.5)	1.0 (0.42–2.6)	0.80 (0.38–1.7)
≥ 2 comorbid conditions vs. none	0.89 (−0.62 to 4.1)	0.470	1.3 (0.77–2.0)	1.9 (1.2–3.1)	0.71 (0.41–1.2)	1.2 (0.47–3.0)	0.82 (0.42–1.6)
Diabetes not priority	−5.0 (−9.4 to −0.67)	0.026	2.3 (1.2–4.5)	1.3 (0.76–2.2)	2.6 (1.4–5.1)	1.3 (0.55–3.2)	1.3 (0.81–2.2)
Take pain medication	5.9 (2.3–9.5)	0.003	0.38 (0.13–1.1)	0.91 (0.65–1.3)	0.44 (0.28–0.68)	0.56 (0.33–0.95)	0.83 (0.43–1.6)

Data are adjusted OR (95% CI) unless otherwise stated.
*
↵* All models were adjusted for the variables listed as well as for annual household income, education, insulin use, age, sex, race, BMI, and for clustering by site.