Original Research

A Treatment Protocol for Patients With Diabetic Peripheral Neuropathy

Fed Pract. 2015 September;32(9):68-73

References

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Physical therapy may be prescribed for DPN and its resulting sequelae. Several studies present conflicting results regarding the benefits of therapeutic exercise in the treatment of DPN. Akbari and colleagues showed that balance exercises can increase stability in patients with DPN; whereas, a study by Kruse and colleagues noted a training program consisting of lower-extremity exercises, balance training, and walking resulted in minimal improvement of participants’ balance and leg strength over a 12-month period. ^9,10 Recent studies have shown that weight bearing does not increase ulceration in patients with diabetes and DPN. This is contrary to previous assumptions that patients with diabetes and DPN need to avoid weight-bearing activities. ^11,12

Transcutaneous electrical nerve stimulation (TENS), a modality often used in physical therapy, has been studied in the treatment of DPN with conflicting results. Gossrau and colleagues found that pain reduction with micro-TENS applied peripherally is not superior to a placebo. ¹³ However, a case study by Somers and Somers indicated that TENS applied to the lumbar area seemed to reduce pain and insomnia associated with diabetic neuropathy. ¹⁴

Several recent research studies suggest that MIRE, another available modality, may be effective in treating symptoms of DPN. Monochromatic infrared energy therapy is a noninvasive, drug-free, FDA-approved medical device that emits monochromatic near-infrared light to improve local circulation and decrease pain. A large study of 2,239 patients with DPN reported an increase in foot sensation and decreased neuropathic pain levels when treated with MIRE. ¹⁵

Leonard and colleagues found that the MIRE treatments resulted in a significant increase in sensation in individuals with baseline sensation of 6.65 Semmes-Weinstein Monofilament (SWM) after 6 and 12 active treatments as well as a decrease in neuropathic symptoms as measured by the Michigan Neuropathy Screening Instrument. ¹⁶ Prendergast and colleagues noted improved electrophysical changes in both large and small myelinated nerve fibers of patients with DPN following 10 MIRE treatments. ¹⁷ When studying 49 patients with DPN, Kochman and colleagues found 100% of participants had improved sensation after 12 MIRE treatments when tested with monofilaments. ¹⁸

An additional benefit of MIRE treatment is that it can be safely performed at home once the patient is educated on proper use and application. Home DPN treatment has the potential to decrease the burden this population places on health care systems by reducing provider visits, medication, hospitalization secondary to pain, ulceration, fall injuries, and amputations.

Methods

This was a prospective, case series pilot study designed to measure changes in patient pain levels using the visual analog scale (VAS) and Pain Outcomes Questionnaire-VA (POQ-VA), degree of protective sensation loss as measured by SWM, and fall risk as denoted by Tinetti scores from entry to 6 months. Informed consent was obtained prior to treatment, and 33 patients referred by primary care providers and specialty clinics met the criteria and enrolled in the study. Twenty-one patients completed the entire 6-month study. The nonparametric Friedman test with a Dunn’s multiple comparison (DMC) post hoc test was used to analyze the data from the initial, 4-week, 3-month, and 6-month follow-up visits.