title: The effect of chronic pain on diabetes patients' self-management.
abstract: 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.
  
  
  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.
authors.affiliation: Center for Practice Management and Outcomes Research, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan, USA. skrein@umich.edu
authors.forename: Sarah L
authors.initials: SL
authors.lastname: Krein
authors.forename: Michele
authors.initials: M
authors.lastname: Heisler
authors.forename: John D
authors.initials: JD
authors.lastname: Piette
authors.forename: Fatima
authors.initials: F
authors.lastname: Makki
authors.forename: Eve A
authors.initials: EA
authors.lastname: Kerr
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D002908:Chronic Disease; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000503:physiopathology* / Q000534:rehabilitation*; D005260:Female; D006304:Health Status; D006801:Humans; D007182:Income; D008297:Male; D008824:Michigan; D008875:Middle Aged; D015999:Multivariate Analysis; D010146:Pain / Q000534:rehabilitation; D012044:Regression Analysis; D012648:Self Care