title: The contributors of emotional distress in painful diabetic neuropathy.
abstract: OBJECTIVE
  To examine the contribution of demographic, social, clinical and psychological factors to emotional distress in patients with painful diabetic neuropathy (DN).
  
  
  METHODS
  In total, 142 patients with confirmed painful DN underwent detailed clinical and self-assessment measures (Neuropathic Pain Scale, Hospital Anxiety and Depression Scale, Pain Acceptance Questionnaire and Pain Catastrophizing Scale).
  
  
  RESULTS
  The prevalence of emotional distress was 51.4% in this cohort. Age, sex, marital status, employment history, pain intensity, duration of diabetes and the presence of diabetic and non-diabetic complications were significantly correlated to anxiety and depressive symptom scores. Multiple regression analysis confirmed that the presence of catastrophic thinking was an independent contributor to greater symptoms of anxiety and depression. Being young, single and unemployed significantly contributed to greater anxiety symptoms. Pain-related restriction of quality of life was associated with greater depression symptom scores.
  
  
  CONCLUSIONS
  This study found a high prevalence of emotional distress in patients with painful DN. It highlights that the differing independent contributors to anxiety and depressive symptoms are based on an individual's circumstances and experience. We conclude by highlighting the importance of adopting a holistic approach to pain management, incorporating interventions to increase psychological flexibility alongside conventional pharmacological treatments to improve emotional distress in painful DN.
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK d.selvarajah@sheffield.ac.uk.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Selvarajah
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Cash
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Adhithya
authors.initials: A
authors.lastname: Sankar
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Lloyd
authors.initials: L
authors.lastname: Thomas
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Davies
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Elaine
authors.initials: E
authors.lastname: Cachia
authors.affiliation: Diabetes Research Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Gandhi
authors.affiliation: Department of Human Metabolism, The Medical School, University of Sheffield, Sheffield, UK.
authors.forename: Iain D
authors.initials: ID
authors.lastname: Wilkinson
authors.affiliation: Improving Access to Psychological Therapies Sheffield (IAPT), Sheffield Health and Social Care NHS Foundation Trust, Sheffield, UK.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Wilkinson
authors.affiliation: Diabetes Research Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Celia J
authors.initials: CJ
authors.lastname: Emery
authors.affiliation: Diabetes Research Department, Royal Hallamshire Hospital, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK.
authors.forename: Solomon
authors.initials: S
authors.lastname: Tesfaye
keywords: Painful diabetic neuropathy; anxiety; depression; emotional distress