Clinical Research Directory

Inclusion Criteria: * Medical diagnosis of diabetes mellitus (type 1 or type 2) as per patient self-report. * Distal symmetrical peripheral neuropathy (defined as a score of ≥4 on the Michigan Neuropathy Screening Instrument (questionnaire part) (Herman et al., 2012)). * Neuropathic pain as assessed by DN4 questionnaire (defined as a score of ≥3 of 7 self-reported items) (Spallone et al., 2012). * Stable analgesic medication regimen for at least 3 weeks prior to anticipated study enrolment and no revision of regimen planned within the next 3 months. * Stable attendance of out-of-study nonpharmacological therapies for neuropathic pain or professional exercise programmes (including gym classes and manual therapy) for at least 3 weeks prior to anticipated study enrolment and no revision of routine planned within the next 3 months. * Participants capable of giving informed consent themselves. * Participants able to speak, understand, and read English at conversational levels. * Age: 18 and older. Exclusion Criteria: * Contraindications to manual therapy and conservative pain management (as determined by recruiting staff during screening calls or the trial provider at the initial or any other appointment; May include medical emergencies and suspected severe pathology, advanced osteoporosis, and active foot ulcerations) * Past or scheduled amputations * Advanced renal failure * Recent physical trauma and suspected fracture * Currently experiencing severe depressive or other current and severe psychopathology such as bipolar/psychosis, and/or presenting with active suicidal risk * Carpal Tunnel Syndrome diagnosis or symptoms as the only source of neuropathic pain * Unable or unwilling to provide consent for study participation * Unable to attend in-person appointments at treatment site (for health reasons) * Unable to attend in-person appointments at treatment site (for organisational reasons) * Knowing other participants signed up to the study (to avoid group contamination) * Concomitant participation in another clinical intervention study * Changes in medication or physical activity programmes in the past 1 month or planned for the next 3 months.