title: The role of physical activity and psychological coping strategies in the management of painful diabetic neuropathy--A systematic review of the literature.
abstract: BACKGROUND
  Diabetes is rising in prevalence; painful diabetic neuropathy (PDN) is one complication of diabetes. PDN is primarily managed with medication but analgesic failure is common and people remain in pain and distress. It is unclear whether pain management strategies are appropriate for PDN.
  
  
  OBJECTIVE
  To establish the effectiveness of physical activity and psychological coping strategies for PDN.
  
  
  METHODS
  Systematic literature review.
  
  
  METHODS
  Ten online databases.
  Controlled trials reporting specific results for PDN, investigating, (a) physical activity or (b) psychological coping strategies and measuring pain as an outcome. The search was restricted to published research with no restriction on language or date of publication.
  
  
  METHODS
  Methodological quality and risk of bias assessed with Cochrane collaboration and NICE checklist for randomised controlled trials.
  
  
  RESULTS
  Of 1306 titles identified, four studies met the inclusion criteria. Two trials investigated physical activity and two investigated psychological coping interventions. Studies showed pain measures improved or did not worsen compared to controls, but methodological quality was moderate and results need cautious interpretation.
  
  
  CONCLUSIONS
  The studies were of small sample size and used a diverse range of outcome measures. There is high risk of bias from lack of blinding and attrition at follow up.
  
  
  CONCLUSIONS
  The research literature in this area is sparse and inconsistent, despite the pressing clinical challenge of PDN. Firm conclusions cannot be drawn from the studies included. Further high quality research is required to match treatment provision to patient requirements.
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol BS16 1DD, UK. Electronic address: benjamin8.davies@uwe.ac.uk.
authors.forename: Ben
authors.initials: B
authors.lastname: Davies
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol BS16 1DD, UK.
authors.forename: Fiona
authors.initials: F
authors.lastname: Cramp
authors.affiliation: Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1 1RL, UK; Department of Psychology, University of Bath, Bath BA2 7AY, UK.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Gauntlett-Gilbert
authors.affiliation: Schools of Physiology and Pharmacology and Clinical Sciences, University of Bristol, University Walk, Bristol BS8 1TD, UK.
authors.forename: David
authors.initials: D
authors.lastname: Wynick
authors.affiliation: Faculty of Health and Applied Sciences, University of the West of England, Blackberry Hill, Bristol BS16 1DD, UK; Royal National Hospital for Rheumatic Diseases, Upper Borough Walls, Bath BA1 1 1RL, UK.
authors.forename: Candida S
authors.initials: CS
authors.lastname: McCabe
mesh_terms: D000223:Adaptation, Psychological; D002986:Clinical Trials as Topic; D003929:Diabetic Neuropathies / Q000523:psychology* / Q000534:rehabilitation*; D015444:Exercise; D006801:Humans; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement
keywords: Diabetes; Pain; Physical activity; Psychological coping; Systematic literature review