What Do Depression, Anxiety, and Sleep Disturbances Have To Do With Neuropathy?
By Natacha T. Pires, M.B.B.S., Director of Medical and Public Affairs, The Neuropathy Association

Editor’s Note: This is the first in a series of articles aimed at helping you better understand the link between anxiety, depression, sleep disturbances, and neuropathy.

Neuropathy 24/7/365
Neuropathy is a 24/7/365 battle for many in our community. And, much like other chronic diseases, neuropathy has physical, emotional, and psychosocial components that can be overwhelming and can complicate your health care provider’s efforts to help you effectively manage your neuropathy.1

“What should I expect with neuropathy five or ten years down the line?” “What treatments are available to better manage my neuropathy? I’ve tried everything my doctors have recommended…nothing works.” “I feel hopeless and isolated because my family and friends do not understand what is happening to me.” These are just a few concerns that can be overwhelming and set the stage for co-morbid (or associated) conditions such as anxiety, depression, sleep disturbances, and cognitive impairments. These comorbidities may not always appear at diagnosis; they surface over time, and are often unreported and untreated because we—patients and health care providers alike—are focused on the physical symptoms of neuropathy such as neuropathic pain, lack of coordination, and imbalance to name a few.

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Why Is It Important to Recognize Neuropathy’s Comorbidities?
Results from numerous studies have demonstrated that chronic pain and neuropathic pain both negatively affect quality of life.2 One of the first steps toward understanding chronic diseases is recognizing its existence and its toll. Between 30% and 60% of all patients diagnosed with a chronic illness report having feelings of depression and anxiety.When comorbid, pain, depression, anxiety, cognitive impairments, and sleep disturbances slow the treatment of each other and worsen physical and psychological disability, thus increasing neuropathy’s burden and making its management even more of challenge.4 According to Steven Feinberg, M.D. (adjunct associate clinical professor at Stanford University School of Medicine), “The real pain comes from ‘the losses:’ losing a job, losing respect as a functional person, loss of sexual relations…all of these make people depressed.”5
It is also important to recognize the similarities between depression and chronic pain. Both chronic illnesses are exacerbated by stressors; share some of the same chemical messengers (or neurotransmitters) traveling between nerves; and, share some of the same nerve pathways. These similarities help us understand how--and why--optimal treatment strategies use a combination of behavioral and pharmacological approaches known to improve both the physical neuropathic pain symptoms and the symptoms of depression and anxiety.6
What Can You Do To Better Cope With Neuropathy and Its Comorbidities?
Because the symptoms of neuropathy and its comorbidities vary from one patient to another, treatment is individualized. A number of factors affect treatment strategies: the underlying cause, co-existing medical conditions, your current and past medication history, and other individual factors such as biology. And, what works for one person does not always work for the next person. It is also important to understand that there are therapies that can improve pain symptoms—but not eliminate them completely.7 But, addressing the comorbidities can help improve treatment outcomes in general. Understanding and accepting this helps set achievable treatment goals with your physician.

Neuropathy’s comorbidities can often go undiagnosed because you—and your health care provider—may be focused on managing neuropathy’s primary symptoms (e.g., neuropathic pain, imbalance, weakness).8 It is important to talk with your health care provider if you are experiencing symptoms of anxiety, sleep disturbances, feelings of helplessness, loss of (or increased) appetite, and fatigue. Your health care provider will help you better understand these symptoms and work with you to manage them. Often, this could mean taking a coordinated multidisciplinary approach to managing your neuropathy. Depending on your needs, your health care provider might refer you to a range of specialists (for pain management, psychiatry, psychology, podiatry, occupational therapy, and physical therapy, to name a few) to help better manage your symptoms.

Managing neuropathy is about finding a balance between the benefits of therapy (and often the use of combination therapy) and the side-effects, the goal being reduction of pain and other co-morbidities to restore functionality, psychological well being, and quality of life.  

1.-8. Jain R, Jain S, Raison C, L., and Maletic V. “Painful Diabetic Neuropathy is More Than  Pain  Alone: Examining the Role of Anxiety and Depression as Mediators and Complicators” Current Diabetic Reports 11.4 (2011): 275-84

2. McCarberg B. H. and Billington R. “Consequences of Neuropathic Pain: Quality-of-Life Issues and Associated Costs” American Journal of Managed Care 12. 9 (2006): S263-68

3. (Accessed Sept. 24, 2011)

4. Karp J. P., and Reynolds, III C. F. “Depression, Pain, and Aging” Focus 7 (2009): 17-27

5.-6. WebMD Website, (Accessed on Sept. 21, 2011)

7. Argoff C. E., Backonja M. et al, “Consensus Guidelines: Treatment Planning and Options” Mayo Clinic Proceedings 81.4 (2006):  S12-25


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