Adding PEMF to Medications for Diabetic Peripheral Neuropathy

Page | 007

Shanb et al
axon regeneration.35 It increases adenosine triphosphate synthesis and both serotonin and endorphins secretions.22 The combined effects of all these various mechanisms can justify the induced positive effects of LLLT on the pathogenesis of DPN. 24
In contrast to the current results, Bril et al14 recommended that LLLT cannot be used as a treatment modality for DPN. Also, Zinman et al26 did not support its usage in DPN because they did not find any sufficient evidence for the usage of LLLT in painful DPN. The different laser responses might be due to the differences in the intervention time adopted in the 2 studies.21 They found LILT has non-significant influences on MCV and SCV values in patients with painful DPN. The LLLT parameters used in the current study are completely different from those applied in a study by Peric and Cvetkovic.21 They applied laser therapy for one minute/ site on nine points, while in the current study the target areas were the plantar surface of the feet and the lumbo- sacral area. Each one was exposed for 15 minutes 2 times per week for 3 months. In addition, the patients received laser therapy only without proper medical control in Peric and Cvetkovic,21 whereas in the current study, the patients received laser therapy combined with proper analgesic medications. The proper parameters of laser application are still controversial in the literature, and consequently high scientific rigor is needed to define the optimum LLLT protocol which is specific in the treatment of DPN.20 There are numerous factors can influence the effects of LLLT such as the type of laser, radiation characteristics, the type of underlying pathology, and treatment regimens such as specific type of laser radiation can have different results on different pathologies.24 Consequently, more studies may be needed prior to generalizing these results.36,37
This study also revealed a significant reduction in the VAS score in the 3 treated groups with non-significant differences among them. It means that proper medical treatment alone or in addition to magnetic or laser interventions can achieve satisfactory analgesic effects for patients with DPN.4,11,27 Thus analgesic medications are still the most commonly used option to manage DPN. These drugs can achieve the analgesic effects for neuropathic pain with wide variability depending upon the used drugs and the extent of underlying neuropathic pathology changes.11,23 In addition, in the long run, the required analgesic doses of those patients who will be exposed to magnetic or laser therapy will be less because of extra positive changes in underlying neuropathic pathology. The TRCNSS reduced significantly after adding either magnetic or laser therapy to drug therapy, but non-significant reductions were obtained in those patients who received only drug therapy. This may be due to the fact that TRCNSS includes a pain measure in addition to other parameters such as touch sensation, tendon reflexes and vibration sense which improved significantly in those patients exposed to both magnetic
and laser therapy because of the achievements of other physiological advantages in addition to the effectiveness of drug therapy.
Unfortunately, the results of the current study did not find any significant differences between the effects of adding either magnetic therapy or laser therapy to drug therapy in patients with DPN. To the best of investigators’ knowledge, no previous study compared both magnetic therapy and laser therapy combined with analgesic medications.
Conclusion
It was concluded that the addition of either magnetic or laser therapy to analgesic medications could bring extra positive therapeutic benefits to patients with DPN. There were non-significant differences between the effect of both magnetic and laser therapy on DPN. Both magnetic and laser therapy can be applied in combination with analgesic medications as therapeutic modalities for the treatment of patients with DPN.
Limitations
Small sample size, evaluation with measurements taken only before and after treatment without long-term follow-up.
Recommendations
Further studies are needed to compare the effects of different intensities of laser and magnetic on DPN using a larger sample size for a longer time and with long-term follow up.
Ethical Considerations
All procedures were approved by the Ethics Research Committee of the Institutional Review Board of Imam Abdualrahman Bin Faisal University (IRB-2014-04- 061.No. 2014171). Also, This study was registered in ClinicalTrials.gov (Identifier: NCT03049605).
Conflict of Interests
The authors declare no conflict of interest.
Funding
This research is a grant project. It was financially supported by the Dean of Scientific Research of Imam Abdulrahman Bin Faisal University, KSA.
Acknowledgement
The authors thank the Dean of Scientific Research of Imam Abdulrahman Bin Faisal University for financial support, Dr Turki Abualait, the chairman of the department; Mahmoud Elsayed Shanab, Mr Anas Alqarni, Belal Elsayed Shanb, and Ms Manar Al Masoud (researcher assistants), and all participants for their cooperation and valuable efforts through conducting this research.
26 Journal of Lasers in Medical Sciences Volume 11, Number 1, Winter 2020