Adding PEMF to Medications for Diabetic Peripheral Neuropathy

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recruited as confirmed DPN. 16,21 All measures were performed by using (NicoletTM EDX- Viking version 20 software Germany) at a controlled temperature of 25°C.27,28
1. Peroneal nerve conduction velocity: It was investigated by putting standard surface electrodes. The distal stimulation was applied at 8 cm near to the active pickup electrode, just lateral to the Tibialis Anterior Tendon. The ground electrode was put at mid-calf. The proximal stimulation was applied just below the head of the fibula while the recording electrode was applied over the Extensor Digitorum Brevis to get a supra-maximal stimulus. 4,22,27
2. Sural nerve conduction velocity: It was investigated by putting an active pick-up electrode posterior and below the lateral malleolus. The reference electrode was put at 3 cm distal to the active electrode and the ground electrode was put between the cathode of the stimulator and the active pickup electrode. Stimulation was applied slightly lateral to the midline in the lower third of the posterior aspects of the leg with the cathode distally about 17 cm from the active electrode (10-14 cm). 4,8,22,27
c. Neuropathy Severity
It was also evaluated by the TRCNSS which is an objective method to detect the presence and intensity of DPN. Total scores ranged from 0 (normal) to 19 points (maximum).7
d. Pain
It was measured by VAS which is a valid instrument for the determination of perceived pain. Every patient was asked to point to his or her pain level ranged from 0 (no pain) to 10 (maximal pain). 4,27
e. Vibration Sense
It was evaluated by using a 128-Hz tuning fork from the bony prominence of the big toe. 5
f. Deep Tendon Reflexes
The ankle and knee reflexes were evaluated from relaxed sitting position. 22
Treatment Procedure
Only 90 patients were randomly and equally assigned to 3 treatment groups by an independent blinded research assistant who opened sealed envelopes that contained a computer-generated randomization card (Figure 1).
1. Magnetic group: Twenty-six patients received drug therapy and they were exposed to magnetic therapy by a BEMER mattress (the density of the magnetic field was between 35 and 50 μT for 20 minutes/session, 2 sessions/ week, for 3 months. The BEMER mattress was applied from a relaxed supine lying position. After connecting the appliance to the electrical supply, the action of PEMT was adjusted below the affected parts from the lower back to the feet. The program 3 was applied to achieve the proper
treatment for 20 minutes.29
2. Laser group: Twenty-five patients received drug
therapy and they were exposed to the infrared laser (850 nm) in the continuous wave mode with the total power of 5.7 J/cm2 for 30 minutes /session, 2 times per week, for 3 months. 4,22,27 Both the plantar surface of the feet and the lumbosacral area were treated by laser therapy from a comfortable prone lying position . The distance between the laser head and the treated area of every patient was adjusted at 30 cm. The X-Y dimensions of the lumbo- sacral area were marked by 4 points, one on the lumbar 2, one on the sacral 1, and 2 points laterally to the spine by about 2 cm. The plantar surface and the lumbosacral areas were cleaned with alcohol (95%). Both areas were exposed to laser therapy through a sweeping computerized scan at an angle of 30° ± 15°. The power density was 6.3 mW/cm2 and irradiation time was set to 90 sec/cm2 to achieve the total dose of 5.7 J/cm2 through 15 min/site/session. Every patient and the physical therapist wore protective glasses for protection from the laser beam.4,22,27
3. Drug group: Twenty patients received only their regular drug therapy in the form of anti-diabetic drugs (either oral or insulin) and analgesic medications for peripheral neuropathic pain, including pregabalin (150 mg/d-300 mg/d) and B-complex multivitamin (B-100), one tablet once or twice daily. 9,14,22
Statistical Analysis
All measured variables with their output data were analyzed by using SPSS software (version 23.0) in the form of descriptive and inferential analysis. A repeated measures ANOVA was used to evaluate the therapeutic effects within each group and among 3 groups. ANOVA and Pearson’s chi-square were used to compare demographic data of all groups. Statistical significance was measured at a P value <0.05 with a confidence interval of 95%.
Results
Statistical analysis was applied to seventy-one patients who completed this study (Figure 1) as nineteen patients dropped out.
Demographic Characteristics of Recruited Patients
The data were reported by using the percent. The Pearson chi-square showed non-significant differences in gender and used drugs among the 3 groups. The results of ANOVA proved non-significant differences in the mean values of age, body mass index (BMI), FBG, the duration of diabetes, and the beginning of neuropathy among 3 groups prior to the interventions. The baseline demographic data were similar among the 3 groups except for increases number of participated men than women (Table 1).
Rate of Adherence
The mean values of patients’ adherence of both magnetic
Electromagnetic Therapy Versus Laser Therapy on Peripheral Neuropathy
Journal of Lasers in Medical Sciences Volume 11, Number 1, Winter 2020 23