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2019 | 23 | 110-127
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Effectiveness of electrical stimulation and low-intensity laser therapy on diabetic neuropathy: A systematic review

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Diabetes mellitus (DM) is a group of metabolic diseases which typically presents with frequent urination, increased thirst and increased hunger. DM be classified into three main types: type I (insulin-dependent DM), type-II (non-insulin dependent DM) and type III (gestational DM). Diabetes is a group of diseases of global health significance as 382 million people worldwide had diabetes in the year 2013 and this was projected to increase to an estimated 415 million in 2015. Damage to the nerves of the body (diabetic neuropathy) is the most common complication of diabetes. The signs and symptoms of diabetic neuropathy include numbness, diminished sensation, pain etc. Various types of electrotherapy, such as transcutaneous electrical nerve stimulation (TENS), pulsed-dose electrical stimulation, frequency-modulated electromagnetic neural stimulation, have been reported effective in managing diabetic neuropathy. This study is a systematic review of the evidence to enable the determination of the effectiveness of electrical stimulation and low-intensity laser therapy (LILT), and also aid their recommendation if proven to be effective. The outcome of this study was that TENS and other forms of electrical stimulation reviewed in this study may be effective and safe non-pharmacological treatment modalities in relieving the symptoms associated with diabetic neuropathy. The effectiveness of LILT couldn’t be determined due to the different parameters used to evaluate patients’ outcome and limited number of studies. Authors recommend that further randomized controlled trials with similar methodological parameters and studies with higher quality of evidences are needed to establish the true effectiveness of these modalities in diabetic neuropathy.
Physical description
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Physiotherapy, University of Ibadan, Ibadan, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • Department of Medical Rehabilitation, Obafemi Awolowo University, Ile-Ife, Nigeria
  • [1] Abouaesha, F., van Schie, C., Griffths, G., Young, R., & Boulton, A. (2001). Plantar tissue thickness is related to peak plantar pressure in the high-risk diabetic foot. Diabetes Care 24, 1270–1274
  • [2] Ailioaie, C., & Lupusoru-Ailioaie, L. (1999). Beneficial effects of laser therapy in the early stages of rheumatoid arthritis onset. Laser Theraphy 11, 79–87
  • [3] Alvaro, M., Kumar, D., & Julka, I. (1999). Transcutaneous electrostimulation: emerging treatment for diabetic neuropathic pain. Diabetes Technol Ther 1, 77–80
  • [4] Armstrong, D., Lavery, L., Fleischli, J., & Gilham, K. (1997). Is electrical stimulation effective in reducing neuropathic pain in patients with diabetes? J Foot Ankle Surg 36(4), 260–263
  • [5] Balducci, S., Iacobellis, G., L., P., Di Biase, N., Calandriello, E., & Leonetti, F. E. (2006; ). Exercise training can modify the natural history of diabetic peripheral neuropathy. Diabetes Complications 20, 216-223
  • [6] Bhadada, S., Sahay, R., V.P, J., & Agrawal, J. (2001). Diabetic Neuropathy: Current Concepts. Journal Indian Academy of Clinical Medicine 2 (4), 306-318
  • [7] Bosi, E., Conti, M., Vermigli, C., Cazzetta, G., & Peretti, E. (2005). Effectiveness of frequency-modulated electromagnetic neural stimulation in the treatment of painful diabetic neuropathy. Diabetologia 48, 817-823
  • [8] Boulton, A., Hardisty, C., Betts, R., Franks, C., Worth, R., & Ward, J. e. (1983). Dynamic foot pressure and other studies as diagnostic and management aids in diabetic neuropathy. Diabetes Care 6, 26-33
  • [9] Boulton, A., Malik, R., Arrezo, J., & Sosenko, J. (2004). Diabetic somatic neuropathies. Diabetes Care 27, 1458–1486
  • [10] Brink, T. (1995). Induration of the diabetic foot pad: another risk factor for recurrent neuropathic plantar ulcers. Biomed Technik 40, 205–209
  • [11] Carrington, A., Abbott, C., Griffiths, J., Jackson, N., Johnson, S., & Kulkarni, J. e. (2001). . Peripheral vascular and nerve function associated with lower limb amputation in people with and without diabetes. Clin Sci (Lond), 101, 261–266
  • [12] Cheer, K., Shearman, C., & Jude, E. (2009). Managing complications of the diabetic foot. BMJ 339, 1304–1307
  • [13] Fisher, M., Langbein, W., Collins, E., Williams, K., & Corzine, L. ( 2007). Physiological improvements with moderate exercise in type II diabetic neuropathy. Electromyogr Clin Neurophysiol 47, 23–28
  • [14] Forst, T., Nguyen, M., Forst, S., Disselhoff, B., Pohlmann, T., & Pfützner, A. (2004). Impact of low frequency transcutaneous electrical nerve stimulation on symptomatic diabetic neuropathy using the new Salutaris device. Diabetes Nutr Metab 17, 163–168
  • [15] Galer, B., Gianas, A., & Jensen, M. (2000). Painful diabetic neuropathy:epidemiology, pain description, and quality of life. Diabetes Res Clin Prac 47, 123-128.
  • [16] Gilcreast, D., Stotts, N., Froelicher, E., Baker, L., & Moss, K. (1998). Effect of electrical stimulation on foot skin perfusion in persons with or at risk for diabetic foot ulcers. Wound Repair Regen 6, 434-441
  • [17] Harris, M., Eastman, R., & Cowie, C. (1993). Symptoms of neuropathy in adults with NIDDM in the U.S. population. Diabetes Care 16, 1446–1452
  • [18] Humpert, P. M., Morcos, M., Oikonomou, D., Schaefer, K., Hamann, A., Bierhaus, A., et al. (2009). External electric muscle stimulation improves burning sensations and sleeping disturbances in patients with type 2 diabetes and symptomatic neuropathy. Pain Med 10, 413–41.
  • [19] International Diabetes Federation. (2013). IDF Diabetes Atlas (6th ed.). Brussels, Belgium: International Diabetes Federation.
  • [20] International Diabetes Federation. (2015). IDF Diabetic Atlas: Update 2015. International Diabetes Federation, 13.
  • [21] Jacobs, M., Jorning, P., Joshi, S., Kitslaar, P., Slaaf, D., & Reneman, R. (1988). Epidural spinal cord electrical stimulation improves microvascular blood flow in severe limb ischemia. Ann Surg 207, 179–183
  • [22] Julka, I., Alvaro, M., & Kumar, D. (1998). Beneficial effects of electrical stimulation on neuropathic symptoms in diabetes patients. J Foot Ankle Surg 37, 191–194
  • [23] Jung, S., & Pfeifer, M. (1986). Persons with diabetes and neuropathic symptoms have poor psychosocial adjustments. Diabetes 35, Suppl: 123
  • [24] Kaada, B. (1982). Vasodilation induced by transcutaneous nerve stimulation in peripheral ischemia: Raynaud’s phenomenon and diabetic polyneuropathy. Eur Heart J 3, 303–314
  • [25] Kirigia, J., Sambo, H., Sambo, L., & Barry, S. (2009). Economic burden of diabetes mellitus in the WHO African region. BMC International Health on Human Rights 9, 6
  • [26] Klassen, A., Di Iorio, B., Guastaferro, P., Bahner, U., Heidland, A., & De Santo, N. J. (2008). High-tone external muscle stimulation in end-stage renal disease: effects on symptomatic diabetic and uremic peripheral neuropathy. J Ren Nutr 18, 46–51
  • [27] Kumar, D., & Marshall, H. (1997). Diabetic peripheral neuropathy: amelioration of pain with transcutaneous electrostimulation. Diabetes Care 20, 1702–1705
  • [28] Kumar, D., Alvaro, M., Julka, I., & Marshall, H. (1998). Diabetic peripheral neuropathy. Effectiveness of electrotherapy and amitriptyline for symptomatic relief. Diabetes Care 21, 1322–1325
  • [29] Malik, R., Newrick, P., Sharma, A., Jennings, A., Ah-See, A., Mayhew, T., et al. (1989). Microangiopathy in human diabetic neuropathy: relationship between capillary abnormalities and the severity of neuropathy. Diabetologia 32, 92–102
  • [30] Martin, T., Stein, R., Hoeppner, P., & Reid, D. (1992). Influence of electrical stimulation on the morphological and metabolic properties ofparalyzed muscle. J Appl Physiol 72, 1401–1406
  • [31] Matjacić, Z., & Zupan, A. (2006). Effects of dynamic balance training during standing and stepping in patients with hereditary sensory motor neuropathy. Disabil Rehabil 28, 1455–1459
  • [32] Mima, T., Oga, T., Rothwell, J., Satow, T., Yamamoto, J., & Toma, K. e. (2004). Short-term high frequency transcutaneous electrical nerve stimulation decreases human motor cortex excitability. Neurosci Lett 355, 85–88
  • [33] Musaev, A., Guseinova, S., & Imamverdieva, S. (2003). The use of pulsed electromagnetic fields with complex modulation in the treatment of patients with diabetic polyneuropathy. Neurosci Behav Physiol 33, 745–752
  • [34] Oyibo, S., Breislin, K., & Boulton, A. (2004). Electrical stimulation therapy through stocking electrodes for painful diabetic neuropathy: a double blind, controlled crossover study. Diabet Med 21, 940–944
  • [35] Passarella, S. (1989). He-Ne laser irradiation of isolated mitochondria. J Photochem Photobiol B 3, 642–643
  • [36] Reichstein, L., Labrenz, S., Ziegler, D., & Martin, S. (2005). Effective treatment of symptomatic diabetic polyneuropathy by high-frequency external muscle stimulation. Diabetologia 48, 824–828
  • [37] Shoback. (2011). Greenspan's basic and clinical endocrinology. (D. G. Gardner, & Dolores, Eds.) New York: McGraw-Hill Medical.
  • [38] Tesfaye, S., Boulton, A., & Dickenson, A. (2013). Mechanisms and management of diabetic painful distal symmetrical polyneuropathy. Diabetes Care 36, 2456-2465
  • [39] Thomas, P. (1973). Metabolic Neuropathy. Journal of College Physicians, London, 7, 154-160
  • [40] Uccioli, L., Giacomini, P., & Monticone, G. (1995). Body sway in diabetic neuropathy. Diabetes Care 18, 339–344
  • [41] Walker, J. (1983). Relief from chronic pain by low power laser irradiation. Neurosci Lett 43, 339–344
  • [42] Watkins, E., & Koeze, T. (1993). Spinal cord stimulation and pain relief. BMJ 307, 462
  • [43] Weintraub, M., & Cole, S. (2004). Pulsed magnetic field therapy in refractory neuropathic pain secondary to peripheral neuropathy: electrodiagnostic parameters – pilot study. Neurorehabil Neural Repair 18, 42–46
  • [44] Weintraub, M., Herrmann, D., Smith, A., Backonja, M., & Cole, S. (2009). Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial. Arch Phys Med Rehabil 90, 112–1109
  • [45] Weintraub, M., Wolfe, G., Barohn, R., Cole, S., Parry, G., G., H., et al. (2003). Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized, double-blind, placebo-controlled trial. Arch Phys Med Rehabil 84, 736–746
  • [46] Wild S, R. G. (n.d.).
  • [47] World Health Organization. (2008). Retrieved October 9, 2016, from
  • [48] World Health Organization. (2014). About diabetes.
  • [49] World Health Organization. (2013). Diabetes Fact Sheet.
  • [50] World Health Organization. (2014). Diabetes Programme.
  • [51] Wróbel, M., Szymborska-Kajanek, A., Wystrychowski, G., Biniszkiewicz, T., Sieroń-Stołtny, K., & Sieroń, A. e. (2008). Impact of low frequency pulsed magnetic fields on pain intensity, quality of life and sleep disturbances in patients with painful diabetic polyneuropathy. Diabetes Metab 34, 349-354
  • [52] Yamamoto, H., Ozaki, A., Iguchi, N., & Kinoshita, S. (1988). Antinociceptive effects of laser irradiation of Hoku point in rats. Pain Clin 8, 43-48
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