Transcutaneous electrostimulation: emerging treatment for diabetic neuropathic pain.

Three independent studies utilizing transcutaneous electrical nerve stimulation to relieve diabetic peripheral neuropathic pain were reviewed. The proprietary equipment, an H-wave machine, administered all electrotherapy. The first two studies assessed the efficacy of electrotherapy alone and electrotherapy with amitriptyline. The treated electrotherapy group reported an overall greater reduction of symptoms, 52% with 2-3 weeks of active treatment. Amitriptyline alone produced a 26% reduction of pain after 4 weeks. The addition of active electrotherapy to amitriptyline produced a 66% reduction of pain. The final study looked at patients who have utilized electrotherapy for over one year. A reported 44% improvement of symptoms was attained with continuous electrotherapy treatment. The data also suggested that a maintenance treatment protocol for long-term pain relief would have to be developed.

Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for symptomatic relief.

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 < 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 < 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 < 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.

Beneficial effects of electrical stimulation on neuropathic symptoms in diabetes patients.

Transcutaneous electrical nerve stimulation is utilized for relieving pain in the diabetes peripheral neuropathy. Previous studies were short-term and did not document sustained beneficial effects. In this study, the authors evaluated long-term effectiveness of electrotherapy administered by proprietary equipment, an H-wave machine. A detailed questionnaire concerning patients' symptoms prior to and following electrotherapy was mailed to the users of H-wave machine. The responses of 34 individuals who had diabetes mellitus were analyzed (age 74.1 +/- 1.6 SEM years, body mass index 28.5 +/- 0.8 kg/m2, duration of diabetes 15.8 +/- 2.0 years and duration of neuropathic symptoms 8.0 +/- 1.8 years). Telephone interviews were conducted with 20 additional diabetes patients selected randomly from the persons who did not return the questionnaire. Forty-one (76%) patients reported a 44.0 +/- 4.0% subjective improvement in their neuropathic pain. The overall improvement in pain was also significant on an analog scale of 10 (p < .01), and correlated well with the percent amelioration data (r2 = .65). These data suggest an effectiveness of electrotherapy in managing neuropathic pain as an adjunct to the analgesics. It appears to provide continued benefit as the responders have used this nonpharmacological treatment modality for an average period of 1.7 +/- 0.3 years.