Adding PEMF to Medications for Diabetic Peripheral Neuropathy

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To date, although one-third of diabetic patients are affected with neuropathic pain, its treatment is still very complex.6 The focus of management is usually on disease modifications and the relief of symptomatic pain. Up till now, no specific treatment has been able to completely prevent or reverse the progression of DPN.6 As hyperglycemia is the essential contributing factor in DPN, proper glycemic control is the main therapeutic target for its treatment.8 Neuropathy happened because of reductions in the nerve blood flow and increases in nerve hypoxia, thus vasodilating drugs as prostaglandin analogues are usually beneficial in the treatment of neuropathic pain.4,9 Although many drugs have been used for the treatment of DPN, their roles are still unconfirmed.10 The administration of analgesics as tricyclic anti-depressants and topical agents may be effective but with limited success and unsatisfactory results.11 However, around half of the patients with DPN have shown adequate symptomatic pain relief in association with frequent side effects such as drowsiness, lethargy and unsteadiness.11 In addition, these analgesics do not stop or delay the progression of the underlying pathological neuropathic changes.12
Physical therapy can actively relieve the signs and symptoms of DPN. Active exercises have had many benefits for diabetic patients.1,3,5,8 At the same time, there are limitations for many diabetic patients to practice physical exercise, which enforce us to seek other alternative therapeutic modalities for diabetic neuropathic pain.1 Magnetic and laser therapy are recent interventions that may enhance the treatment of DPN.13,14
Pulsed electro-magnetic therapy (PEMT) was applied mostly to animals in experimental studies.15 The application of PEMT for 12 consecutive days for 30 minutes relieved neuropathic pain and increased nerve conduction velocity.16 In general, PEMT is considered safe and supplemental therapy for DPN.17 Unfortunately, there are still contradictions about the benefits of magnetic therapy despite its wide uses on diabetic patients.15,16,18 The application of PEMT for 20 minutes/session for 3 weeks resulted in a non-significant improvement in pain intensity and sleep conditions of patients with DPN.18 The properly used parameters for the clinical application of PEMT are also still controversial.14 Its limited uses on human beings aroused our enthusiasm for increasing applied studies into the effects of magnetic therapy on human beings.15
Low-level laser therapy (LLLT) is generally and safely applied to many patients with co-morbid diseases.19,20 There is an unambiguous piece of evidence that LLLT with different wavelengths has different effects on the cellular level.21 It was previously applied for 1 minute/ site on 4 para-vertebral points in the lumbosacral spine, 3 points on the ischial region, and 2 points on the dorsum of the foot. 21 Also, LLLT has been applied on 6 para-spinal points (L4-S1) to irradiate along the output of the right
and left sciatic nerve.22 Despite a wide range of LLLT uses in a clinical setting, there is non-sufficient evidence to confirm its effects on neuropathic pain in humans.23 Some authors suggested its usage as a new therapeutic modality for patients with DPN.24 and others proved that LLLT has been effective in the repair of nerve damage.25 However, objective clinical studies have failed to detect the exact benefits of laser therapy on DPN.26 Furthermore, up till now, there have been controversies over the effects and proper parameters of laser application techniques that can be used for the treatment of DPN to prevent unnecessary sufferings and to reduce direct and indirect costs to those patients and their families.20 There is still a need for more randomized controlled trials on physical therapy advanced modalities for the treatment of patients with DPN.23 Therefore, the objective of the current study was to investigate the effects of adding either magnetic or laser therapy to drug therapy in patients with DPN and to compare them.
Materials and Methods
Subjects
Nineteen type-II diabetic patients with peripheral neuropathy were enrolled in this study after screening by specialized physician (Figure 1). The patients’ demographic data, including age, sex, the duration of diabetic history and beginning of neuropathy, the body mass index, fasting blood glucose (FBG), and the used medications are shown in Table 1.
Inclusion criteria: Patients (male and female) with painful DPN lasted > 6 months. Their age ranged from 35 to 70 years. Patients have sensory abnormalities, burning pain with paresthesia in both lower extremities,4,27 impaired sensory and/or motor conduction velocity (MCV) in a minimum one nerve of the lower limbs.13 All patients were medically controlled. The usage of analgesic medications such as anti-depressants and anticonvulsants could be received without any change for at least 4 weeks prior to recruitment and during the study.4,6 A consent form was signed by all the patients prior to their participation. They were informed that the collected data would be published.
Exclusion criteria: The patients were excluded if they
had DPN from other causes than diabetes, lack of blood
sugar control, vascular insufficiency, other neurological
impairments, uncontrolled medical conditions (e.g.
tumors and thyroid dysfunctions), pregnancy, metallic
implantation, drug abuse, and a TRNCSS total score <5.4,7,8,27,28
Treatment Equipment
1- BEMER mattress: BEMER International AG (Liechtenstein) mattress product was used for producing magnetic therapy. The maximum average flux density (intensity) of BEMER on its highest output level is 150 microtesla (μT). The B. BOX Professional control units
Electromagnetic Therapy Versus Laser Therapy on Peripheral Neuropathy
Journal of Lasers in Medical Sciences Volume 11, Number 1, Winter 2020 21