To Örebro University

Aim: Diabetic sensory neuropathy is a frustrating condition as lack of pain and symptoms reduce patients’ motivation to avoid activities, such as walking without shoes, that result in foot ulcers and counteract healing. Theoretical developments are needed to better understand patients’ situation and develop interventions to change counterproductive behaviors.

Methods: A literature analysis was conducted.

Results: The fear-avoidance model is a cognitive-behavioral account of why some people with acute pain develop chronic pain (1). Intriguingly, the situation of people with chronic pain mirrors the situation of people with diabetic neuropathy and foot ulcers; in chronic pain, counterproductive beliefs and behaviors transform acute pain into a vicious circle of chronic pain (Fig. 1a), in diabetic neuropathy, counterproductive beliefs and behaviors transform acute foot ulcers into a vicious circle of chronic foot ulcers (Fig. 1b). Thus, the situation of people with diabetic neuropathy could be described with a “no fear-avoidance model”, which as the fear-avoidance model could be used to guide research, educate patients, and develop interventions.

Conclusions: The “no fear-avoidance model” seems promising for understanding people with diabetic neuropathy and for developing appropriate interventions, building on work on the fear-avoidance model. For example, interventions based on the fear-avoidance model (activity exposure with feedback, patient education using the model with individual beliefs and behaviors as examples, etc.) could be adapted for people with diabetic neuropathy. By this, we may be able to change inadequate beliefs and behaviors, resulting in more effective prevention and treatment of foot ulcers.