Neuropathy And Electro Stimulation Part 2

Today's post from absolutept.com (see link below) is the second of 4 looking at the qualities and effectiveness of EMS or Tens units in helping reduce neuropathic symptoms. Not all experts are fans of TENS systems, or believe that electro-stimulation is beneficial to neuropathy patients but as with so many of these things in the neuropathy world; they work for many people and bring relief, so deserve to be taken seriously. The problem may be that to get treatment in this area, many people have to go to private clinics and pay outside their normal insurance and that immediately raises the spectre of rampant commercialism and leads people to suspect they're going to be ripped off. This blog doesn't normally advertise but when someone provides useful and fact based information, which is of benefit to everyone considering their treatment options, then there is no objection to highlighting a medical facility. That's the case here. Chad Reilly (sports physical therapist) provides such a comprehensive analysis of EMS/TENS that patients may wish to take it further, either with him or their local TENS provider. Definitely worth reading if you want to know more about how it all works. All four sections appear within these four days.
 

Electric Stimulation and Neuropathy (Part 2)
Chad's Physical Therapy Blog - Chad Reilly

Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for symptomatic relief. Diabetes Care. 1998 Aug;21(8):1322-5. Kumar D, Alvaro MS, Julka IS, Marshall HJ.

From the study:
Abstract

OBJECTIVE:
To evaluate the efficacy of combining electrotherapy with amitriptyline for the management of chronic painful peripheral neuropathy in patients with type 2 diabetes.

RESEARCH DESIGN AND METHODS:
Patients (n = 26) with peripheral neuropathy were treated with amitriptyline. After 4 weeks, those patients (n = 23) who failed to respond to amitriptyline or who only had partial relief were randomized between a sham treatment group (control) or an electrotherapy group. Transcutaneous electrotherapy was given for 12 weeks by a portable unit (H-wave machine) that generated a biphasic exponentially decaying waveform (pulse width 4 ms, 25-35 V, > or = 2 Hz). The degree of pain and discomfort was graded on a scale of 0-5. An analog scale was used to record the overall change in symptoms.

RESULTS:
Amitriptyline produced some degree of symptomatic relief in 15 (60%) of the 26 patients by the 4th week; pain scores decreased from 3.8 +/- 0.1 to 2.9 +/- 0.2 (P and lt; 0.1) and the overall reduction in pain was 26 +/- 5% on an analog scale. In the amitriptyline plus sham treatment group (n = 9), pain scores declined from 2.8 +/- 0.3 to 1.9 +/- 0.5 (P < 0.03) and the overall reduction in pain was 55 +/- 12%, suggesting a procedure-related placebo effect. In the group receiving combined electrotherapy and amitriptyline (n = 14), symptomatic improvement occurred in 12 (85%) patients. Five (36%) of the patients in this group became asymptomatic. Pain scores declined from 3.2 +/- 0.2 to 1.4 +/- 0.4 (P and lt; 0.01) and the overall reduction in pain was 66 +/- 10%. The degree of reduction in pain scores and the incremental relief (above the amitriptyline effect) were significantly greater (P and lt; 0.03) with electrotherapy as compared with sham treatment. The outcomes indicate a substantial beneficial effect of electrotherapy over and above any placebo influence.

CONCLUSIONS:
Our clinical observations suggest that transcutaneous electrotherapy is effective in reducing the pain associated with peripheral neuropathy. This form of therapy may be a useful adjunctive modality when it is combined with a pharmacological agent, such as amitriptyline, to augment symptomatic relief.

My Comments:

This study was conducted by the same authors of the one I reviewed in my prior blog with a focus on decreasing the pain in those with painful neuropathy. Electric stimulation parameters were identical as the prior study…

Parameters:
Waveform: biphasic exponentially decaying
Duty Cycle: continuous (I think)

Pulse Duration: 400 uS
Intensity: 35 mA (max)
Rate: user adjustable from 2-70 Hz
Treatment Length: 30 minutes
Training Frequency: Daily
Training Length: 4 weeks
Electrodes: 4 electrodes; 2 placed on the distal quadriceps, 1 on the neck of the fibula and 1 centered gastrocnemius muscle (size not given)

…but what was different was the combination of electric stimulation with the drug amitriptyline. As noted in the abstract above the electric stimulation led to considerably greater pain reduction than the amitriptyline by itself. The drug seems to have helped as well, as there was an average pain reduction in the electric stim/drug group of 66% with 36% of these subjects became completely asymptomatic in 4 weeks. In the prior study average pain reduction of the electric stimulation (only) group was 52% with 17% becoming completely asymptomatic, so the drug and electric stimulation interaction appears to be complimentary. My first question after reading this study is; what would another 4 weeks of electric stimulation do?

http://absolutept.com/electric-stimulation-and-neuropathy-part-2/