Effectiveness of Exposure in Vivo for Patients with Painful Diabetic Neuropathy: a Pilot Study of Effects on Physical Activity and Quality of Life.

Objective: To evaluate the effects of personalized exposure on level of physical activity and quality of life in patients with painful diabetic neuropathy.

Design: Randomized, single-case, ABC design.

Subjects: Twelve patients with painful diabetic neuropathy, age > 18 years, diabetes mellitus type II, Clinical Neurological Examination score > 5, Diabetic Neuropathy Symptom Score ≥ 1 and Douleur Neuropathique 4 Questions score ≥ 3.

Methods: The treatment consists of an Intensive screening, followed by an 8-week exposure intervention specifically adapted to the needs/risks of patients with painful diabetic neuropathy, and 6-months follow-up. Outcome measures included daily and non-daily measures of physical activity, quality of life, metabolic parameters, disability, depression, general and painful diabetic neuropathy-related anxiety, pain intensity and pain catastrophizing.

Results: Due to high drop-out rates ( = 6 during screening, = 2 during treatment, = 1 after treatment), only 3 participants completed the study. Slight, but non-significant, changes in physical activity and disability were observed. In quality of life, no changes were observed.

Conclusion: Analysis of the reasons for the high drop-out rate indicate that exposure may have added value in patients with painful diabetic neuropathy only for those patients: () whose daily life functioning is impaired mainly by the painful diabetic neuropathy; () in whom painful diabetic neuropathy-related fears are exaggerated and irrational; () in whom specific activities evoke the painful diabetic neuropathy-related fears; () whose spouse and healthcare providers are involved in the treatment; and () who are willing to change their daily behaviour. Further research is needed into this subject.