Currently, diabetes mellitus (DM) is relevant problem, both for its prevalence and complications, including distal polyneuropathy (DPNP). At the same time, discussions continue on analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) in DPNP. Aim of this study was to conduct a multi-faceted assessment of pain syndrome in these patients before and after TENS, taking into account levels of polyneuropathy, its severity and age of patients. The study was conducted in accordance with the research of the Federal State Budgetary Institution of the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation (CTR No. 121040100062-3) and with the permission of the Local Ethics Committee (IRB No. 2 dated 14.01.2021). The study included 75 patients with DM type II with DPNP, which are distributed into 3 groups of 25 people: Group 1a, patients received high–frequency TENS (HF); Group Ib, patients received low-frequency TENS (LF); as control, Group C received a standard method of pharmacological therapy without physiotherapy. Intensity of DPNP was evaluated before and after the course of treatment using a visual analog scale (VAS), the McGill Pain Questionnaire (MPQ), and a graphical linear analysis of pain on the neuropathic pain diagnostic questionnaire 4 (DN4) scale. TENS provides an analgesic effect that may exceed pharmacotherapy in terms of efficacy and safety. There was a 65.9% reduction in neuropathic pain according to VAS after a course of application, with the effects remaining up to 34% during the 6-month follow-up. HF TENS provided a higher significant analgesic effects than LF TENS, as it ensures the reduction of pain syndrome according to VAS by 25.8% (p <0.01), and total estimated characteristics - 35.5% (p <0.01), and touch - in at 58.1% (p = 0.001) and according to the scales of the MPQ (S) and DN4 - by 21% (p = 0.007). The observed differences in analgesic effects between HF TENS and LF TENS are based on analyses of pain in the immediate and long-term follow-up periods of type II DM patients with DPNP. These results, based on summation of the estimated parameters of the international pain scales support expectation of an expansion of the the use of analgesic TENS in aging patients suffering with DM of varying severity and extent of DPNP damage, a goal of great scientific and practical importance.
Резюме Цель исследования-изучить влияние наружной контрпульсации (НКП) на эндотелиальную функцию и состояние микроциркуляции у пациентов после реваскуляризации миокарда (стентирование и коронарное шунтирование) с хронической сердечной недостаточностью (ХСН) II-III функционального класса (ФК). Материал и методы. Обследованы 60 больных после реваскуляризации миокарда с ХСН II-III ФК в возрасте от 50 до 75 лет. Все пациенты получали одночасовые процедуры НКП 5 раз в неделю. Курсовое лечение включало 35 процедур. Для оценки состояния микроциркуляторного русла проводили изучение капиллярного кровотока методом лазерной допплеровской флоуметрии. Результаты. Курсовое применение НКП у пациентов с ХСН II-III ФК после реваскуляризации миокарда оказывало корригирующее действие на систему микрогемодинамики. Изменения микроциркуляции были обусловлены нормализацией миогенного и нейрогенного тонуса артериол, усилением осцилляций эндотелиального диапазона. Выраженное благоприятное воздействие НКП на сердечно-сосудистую систему у обследуемых пациентов подтверждалось достоверным повышением толерантности к физической нагрузке, статистически значимым улучшением результатов теста 6-минутной ходьбы. Отмечено уменьшение ФК сердечной недостаточности. Заключение. НКП является эффективным, неинвазивным методом лечения пациентов с сердечной недостаточностью.
The purpose of the paper is to highlight the possibilities of using a low-frequency electrostatic field in clinical practice. On the basis of available literature data and their own clinical observations authors summarize information concerning various aspects of the use of low-frequency electrostatic field in clinical practice, and gives a description of this method of treatment.
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