i_need_contribute
Rhianon Liu,1 Trilce Santana,1 Dean Schillinger,2 Frederick M. Hecht,1,2 and Maria T. Chao1,2,*
Purpose: To explore the experiences of living with painful diabetic neuropathy (PDN) and with a group acupuncture intervention in a sample of low-income, diverse patients.
Methods: We conducted a randomized clinical trial of a 12-week group acupuncture intervention for PDN. Data included validated measures of patient-reported outcomes, including pain and quality of life (QOL), as well as semistructured qualitative interviews about participants' experiences with PDN and the intervention. Interview transcripts were coded and analyzed using an inductive thematic framework.
Results: We recruited 40 participants from diverse racial/ethnic backgrounds from a public hospital and conducted in-depth qualitative interviews with a subset of 17 participants. Participants randomized to acupuncture experienced greater decreases in pain compared with usual care as well as improved QOL. In interviews, they described a myriad of socioeconomic and personal life stressors that compounded the significant suffering and disability brought on by PDN. Those who received acupuncture were able to decrease reliance on pain medication, improve their sleep and daily function, reduce stress, and engage more with their own self-care. They noted that the acupuncture intervention also gave them hope in the face of their chronic disease.
Conclusion: Acupuncture is a valuable adjunct treatment for low-income and marginalized populations with PDN. In addition to reducing pain and improving QOL, acupuncture may offer powerful benefits by increasing patient activation and hope.
Keywords: diabetes, acupuncture, health disparities, quality of life, pain, painful diabetic neuropathy
Neuropathy is one of the most disabling and costly complications of diabetes,1 and greatly impairs patients' quality of life (QOL).2,3 Significant disparities exist in the prevalence, management, and outcomes of diabetes in general and of diabetic neuropathy in particular. Racial/ethnic minorities have higher rates of diabetes, less access to care (including screening and counseling), and higher diabetes-related morbidity and mortality compared with non-Hispanic whites.4 Despite a higher rate of diabetic complications,5 racial/ethnic minorities and low-income patients are less likely to be correctly diagnosed with neuropathy,6 and suffer more sequelae such as loss of protective sensation, foot ulcers, and lower limb amputations.7,8
Current treatments for painful diabetic neuropathy (PDN) are limited, and most are aimed at analgesia. Serotonin/norepinephrine reuptake inhibitors, anticonvulsants, and topical capsaicin are considered superior to placebo for short-term pain control, although there is a dearth of high-quality evidence.9 Up to 40% of patients are treated with opiates,10 despite limited efficacy and significant side effects, including somnolence, dizziness, and nausea.11
Prior research has found that patients with diabetes commonly use complementary health approaches.12,13One emerging nonpharmacologic intervention for neuropathic pain is acupuncture. Acupuncture is now widely recognized as an effective treatment for chronic pain,14 and a recent review concluded that it is likely beneficial for peripheral neuropathy,15 although more evidence is needed. Existing research demonstrates that when available, diverse and low-income patients avail themselves of integrative therapies,16,17 including acupuncture.18,19 Group acupuncture (a method of delivery in which multiple people receive acupuncture in a common area) can reduce cost and facilitate access for medically marginalized populations.20,21 A recent study found that 30% of participants randomized to group acupuncture had clinically relevant reductions in back, neck, or osteoarthritis pain, although noninferiority to individual acupuncture was not established.22
To better understand how PDN impairs QOL, patient perspectives are needed. A recent study demonstrates that PDN impacts patients' physical function, daily life, psychological well-being, and sleep.23 However, there is still a need to give voice to vulnerable patient groups who bear a disproportionate burden of disease and are typically underrepresented in research.24 The aim of this analysis is to explore participants' experiences living with PDN and with group acupuncture, to guide the development of more effective treatments for those most affected.
Research
