The Comparison of Effectiveness of TENS and Placebo TENS in Peripheral Neuropathic Pain in Patients with Type II Diabetes Mellitus

Abstract

A AB BS S T TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10 to 20 percent of patients with diabetes mellitus. Treatment goals include restoring function and improving pain control. In this study we aimed to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and placebo TENS in the treatment of peripheral neuropathic pain in patients with type II diabetes mellitus (DM). M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Forty patients who were diagnosed as type II DM with peripheral neuropathy were enrolled to this study. Patients were randomly divided into two groups as Group A (n= 20) TENS group and Group B (n= 20) placebo TENS group. Forty-eight hours before the beginning of TENS therapy, the drugs used for the treatment of neuropathic pain were discontinued. The electrodes of the TENS were bilaterally placed on the lumbosacral region, 3 cm lateral of the vertebral column. The frequency of the electrostimulation which was used in Group A patients was 80 hertz and the amplitude was high enough to create paresthesia. No electrostimulation was given to Group B patients. TENS was applied 30 minutes daily and the procedure was continued for 20 days in both groups. Visual analog scale (VAS) scores and pain grades of the patients at certain times were taken into account for evaluating the effectiveness of the procedure. R Re es su ul lt ts s: : The demographic data of the groups were not significantly different. Although VAS scores before procedure and on the 5 th day of the procedure were not significantly different between groups (p> 0.05), VAS scores on 10 th and 20 th days of the procedure in Group A were significantly lower than Group B (p< 0.001). There was no significant difference between pain grades of Group A and B at the beginning of the study, but pain grades in Group A were significantly lower than Group B when evaluated at the end of the study (p< 0.001). C Co on nc cl lu us si io on n: : Treatment of the patients with DN is a challenging for the physicians. TENS can be used as an efficient and safe treatment option especially in DN patients in whom pharmachologic treatment is contraindicated or inefficient. Placebo TENS has a limited placebo effect in diabetic neuropathy patients. Bu ul lg gu ul la ar r: : Gruplar arasında demografik veriler yönünden anlamlı farklılık yoktu. İşlem öncesi ve işlemin 5. gününde VAS skorları yönünden gruplar arasında farklılık olmamakla birlikte, Grup A'nın 10. ve 20. günlerdeki VAS skorları grup B'ninkilerden anlamlı olarak daha düşüktü. Çalışma başlangıcında gruplar arasında ağrı dereceleri yönünden fark olmamasına rağmen, çalışma sonunda Grup A'nın ağrı dereceleri Grup B'ninkilerden anlamlı derecede daha düşüktü. S So on nu uç ç: : Diabetik nöropatik ağrısı olan hastaların tedavisi ciddi bir problemdir. TENS özellikle farmakolojik tedavinin kontrendike veya yetersiz olduğu diabetik nöropati hastalarında etkin ve güvenilir bir tedavi...

Characterising the Features of 381 Clinical Studies Evaluating Transcutaneous Electrical Nerve Stimulation (TENS) for Pain Relief: A Secondary Analysis of the Meta-TENS Study to Improve Future Research

“…The majority of TENS interventions were located at the painful site; acupuncture points at the painful site were occasionally chosen [84,152,169,258,363,389,391] (Figure 10). TENS was not administered at the painful site if there was heightened sensitivity and/or poor integrity of the skin associated with painful diabetic neuropathy (TENS administered to the back-dermatomal [66,370]); and for phantom limb pain (TENS administered to the contralateral limb [355]). There were two reports with an unclear statement of TENS location [179,255] and two reports not stating TENS location; in both instances, information within reports confirmed that TENS was delivered at the painful site [171,323].…”

Non-invasive neuromodulation effects on painful diabetic peripheral neuropathy: a systematic review and meta-analysis

“…Descriptive information of the studies' characteristics of each article included is provided in Table 1 and Supplementary Material 4. [25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42] was assessed using the Cochrane tool.…”

“…Effects on pain outcomes. The included studies evaluated the effect of NINMs in painful DPN patients by reporting pain reduction outcomes (14 studies [26][27][28][29][30][31][32][33][34][35][36][37][38][39] ), NCV outcome (three studies [40][41][42], and both of them (one study 25 ). Pain score data were extracted from 15 RCTs (three studies testing central techniques and 12 testing peripheral interventions), which involved 909 patients in total, including 350 patients who were resistant or intolerant to analgesics (baseline pain score: 5.66 ± 1.50), 296 patients who were responders to analgesics (baseline pain score: 5.46 ± 1.72) and 263 patients who had no analgesics related information (baseline pain score: 5.76 ± 1.11).…”

Effects of electrotherapy in neuropathic pain management in patients with diabetic peripheral neuropathy: A narrative review

“…The addition of electromagnetic fields to a physiotherapy program was shown to help better treat pain and increase the rate of peroneal nerve conduction. Four studies have investigated the effect of TENS and all have shown a significant reduction in neuropathic pain [17][18][19][20] . One study found that applying TENS with a frequency of 14Hz and a pulse time of 250μs for 30 minutes, 3 times a week is a more effective treatment for pain relief than aerobic exercise [18] .…”

“…There was a significant reduction in pain intensity and a significant improvement in the peroneal nerve conduction velocity in both groups, with better results coming from the combination of electromagnetic fields and physiotherapy. Regarding other electrical therapies, Bulut et al [17] compared the efficacy of TENS versus placebo TENS in patients with a mean age of 59 years with DMT1 or DMT2 and painful DPN. Group A consisted of 20 patients that received TENS treatment at a frequency of 80 HZ in the lower back, after discontinuing medication for neuropathic pain 48 hours before each treatment.…”