Charlotte C.M. van Laake-Geelen , Rob J.E.M. Smeets, Thijs van Meulenbroek, Marlies den Hollander, Marielle E.J.B. Goossens, Jeanine A. Verbunt
Rehabiliation Medicine, Adelante Centre of Expertise in Rehabilitation and Audiology, 6543 CC Hoensbroek, The Netherlands.
DOI: 10.2340/20030711-1000015

Objective: Painful diabetic neuropathy is associated with low quality of life, depression and anxiety. Patients are limited in their performance of activities of daily living due to fears related to their condition. Treatment modalities are needed to help patients cope with their pain and pain-related disability. Exposure in vivo is an effective treatment in other chronic pain syndromes, increasing patients’ functional ability and quality of life. This paper presents an Exposure in vivo treatment protocol for patients with painful diabetic neuropathy.
Protocol: An 8-week Exposure in vivo treatment protocol was specifically adapted to the needs and risks of patients with painful diabetic neuropathy. New screening tools were developed for patients with PDN; the Painful Diabetic Neuropathy Anxiety Rasch-Transformed Questionnaire (PART-Q30) identifies specific fears related to painful diabetic neuropathy (e. g. fear of hypoglycaemia); and a customized version of the Photograph-series Of Daily Activities (PHODA-PDN) detects fear-eliciting activities related to the condition in individual patients. During Exposure in vivo, catastrophic interpretations regarding painful stimuli are challenged and corrected, thereby diminishing pain-related fear and enabling the patient to re-engage in activities of daily living. An interdisciplinary team provides Exposure in vivo in 1-h sessions twice a week.
Discussion: To the best of our knowledge, this treatment protocol is the first intervention using Exposure in vivo specifically adapted to the needs and risks of patients with painful diabetic neuropathy.

Painful diabetic neuropathy is associated with low quality of life, depression and anxiety. Treatment modalities are needed to help patients cope with their pain and pain-related disability. Exposure in vivo is an 8-week biopsychosocial rehabilitation treatment that aims to restore a normal pattern of daily functioning. During Exposure in vivo, catastrophic interpretations regarding painful stimuli are challenged and corrected, thereby diminishing pain-related fear and enabling patients to re-engage in activities of daily living. An interdisciplinary team provides Exposure in vivo in 1-h sessions twice a week. Current Exposure in vivo treatments are designed for chronic pain conditions that generally have no medical risks or restrictions regarding physical activity. To the best of our knowledge, this treatment protocol is the first Exposure in vivo intervention specifically adapted to the needs and risks of patients with painful diabetic neuropathy. New screening tools were also designed for patients with painful diabetic neuropathy.