This section will present an overview of work done previously that provides the required background for this research purposes. It will concentrates on various issues associated with lower extremity peripheral neuropathy including psychosocial, demographic, and socioeconomic status factors. This section will begin with a thorough coverage of lower extremity peripheral neuropathy problems topics which will assist in setting the context of this research.

Some of the problems associated with lower extremity include diabetes, back and leg pain, peripheral vascular disease, anxiety, depression, panic or panic disorder and other psychological disorders. It is believed that patients suffer from these problems depending on a number of factors such as social background, economic status and psychological factors. According to Peters et al. (2005), it is believed that patients who are from a lower social background are more likely to suffer from diabetic complications as compared to those from a good social background. Peters et al. (2005) conducted a research which suggested that physical risk factors are crucial in foot infection. The research also identified that risk associated with socioeconomic status and the knowledge of foot care is not well-known to the population.

It is not clear why there exist gender differences in diabetes related to lower extremity amputations. In most cases, men have the likelihood of undergoing lower extremity amputations as compared to women who exhibit higher mortality related to lower extremity amputations. The reasons why such differences occur are not clearly known, but it is normally presumed that biological factors play a major role (Peek, 2011). It clearly notable that, there is increased rates of peripheral neuropathy and peripheral vascular disease in men, and interaction between cardiac mortality and gender in women (Peek, 2011). More research is required to determine why such gender differences occur. Racial/ethnic diabetes differences are well documented and with this in mind, it is possible to document the gender diabetes differences as well. Currently, the gender diabetes differences has been ignored and a concise research is recommended in this area to understand why the difference yet we all human beings.

Diabetic lower-limb health problems occur as a result of medical, social and economic factors (Campbell et al., 2000). The lower-limb diabetic problems are the greatest cause of hospitalization for patients suffering from diabetes. According to Campbell et al. (2000), amputations are 15 times more common to people with diabetes than people without diabetes, and people with diabetes constitute 50% of all amputations. Peripheral vascular disease, deformity and infection of the feet, and peripheral neuropathy are the chief impelling factors leading to amputation or ulceration. To reduce such cases, all patients who are diabetic should be entitled to basic foot-care training as well as regular foot checkups. The risk of developing ulceration can be easily be eliminated by basic foot clinical examination. A major common long term complication of type 2diabetic patients is the peripheral neuropathy. A study which was carried out in England implied that 42% of type 2 diabetic people had neuropathy (Boulton, 1998). It is possible to reduce incidence of neuropathy in type 1 diabetes with optimal glycaemic control and intensive therapy by over 50%. The major cause of neuropathy in type 2 diabetes is believed to be hyperglycaemia (Boulton, 1998). Diabetic neuropathy can result to disabilities due to loss of sensibility and pain. Though it has not be practically proofed, surgical relief of pain and restoration of sensation can prevent these complications (Nelson and Little., 2007).

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Singer et al. (2012), states that anxious people can abnormally process threat-related contents. This statement has been affirmed by scientists who have already conducted an extensive body research to demonstrate it. However, it has not been proved the way in which clinical anxiety impacts the selection of frightening signals and their upkeep within consciousness. This is an area which is yet to be explored by scientists. A research conducted by Singer et al. (2012), shows that anxiety disorders are associated with initial enriched selection of threatening signals into awareness. This is normally followed by “disorder-specific manifestation of diminished preferred maintenance of threat in awareness” (Singer et al., 2012, p. 13).

Many controversies have been raised concerning co-occurring depression having negative effects on cognitive behavioral therapy (CBT) outcomes in patients suffering from agoraphobia (AG) and panic disorder (PD) (Emmrich et al., 2012). Another issue which is related to these controversies is whether the treatment of agoraphobia and panic disorder has an effect of reducing depressive symptomatology. According to the research which was conducted by Emmrich et al. (2012), some of the issues raised above were answered as follows; exposure-based cognitive behavioral therapy (CBT) for treating panic disorder and agoraphobia can effectively reduce depressive symptoms and anxiety. In this research, these results were observed irrespective of depressive symptomatology or comorbid depression.

Hypercapnia hypersensitivity is health condition in which the carbon dioxide level in the blood exceeds the required/normal value (Vickers, 2012). Panic disorder patients have been proved to experience this condition. The research concerning hypercapnia hypersensitivity condition has been advanced and it has been found to be a possible endophenotype of panic. Hypercapnia hypersensitivity has been associated with many issues such as panic symptoms and panic attack rate. The panic symptoms associated with hypercapnic hypersensitivity include subjective anxiety, respiratory disturbance and dyspnea. Subjective hypersensitivity is a term which was introduced to represent pronounced anxiety post-hypercapnia. It is defined as an increased self-reported anxiety which can be measured by the use of a visual continuous analog scale. Definitions of these terms have been confusing and this initiated a research which was aimed at clarifying their actual meanings (Vickers, 2012). 

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