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Perrier Q, Moro C, Lablanche S. Diabetes in spotlight: current knowledge and perspectives of photobiomodulation utilization. Front Endocrinol (Lausanne) 2024; 15:1303638. [PMID: 38567306 PMCID: PMC10985212 DOI: 10.3389/fendo.2024.1303638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 02/26/2024] [Indexed: 04/04/2024] Open
Abstract
Introduction Diabetes is a global health concern characterized by chronic hyperglycemia resulting from insulinopenia and/or insulin resistance. The rising prevalence of diabetes and its associated complications (ulcers, periodontitis, healing of bone defect, neuropathy, retinopathy, cardiopathy and nephropathy) necessitate innovative therapeutic approaches. Photobiomodulation (PBM), involves exposing tissues and cells to low-energy light radiation, leading to biological effects, largely via mitochondrial activation. Methods This review evaluates preclinical and clinical studies exploring the potential of PBM in diabetes and its complications, as well all clinical trials, both planned and completed, available on ClinicalTrials database. Results This review highlights the variability in PBM parameters across studies, hindering consensus on optimal protocols. Standardization of treatment parameters and rigorous clinical trials are needed to unlock PBM's full therapeutic potential. 87 clinical trials were identified that investigated PBM in diabetes mellitus (with 5,837 patients planned to be treated with PBM). Clinical trials assessing PBM effects on diabetic neuropathy revealed pain reduction and potential quality of life improvement. Studies focusing on wound healing indicated encouraging results, with PBM enhancing angiogenesis, fibroblast proliferation, and collagen density. PBM's impact on diabetic retinopathy remains inconclusive however, requiring further investigation. In glycemic control, PBM exhibits positive effects on metabolic parameters, including glucose tolerance and insulin resistance. Conclusion Clinical studies have reported PBM-induced reductions in fasting and postprandial glycemia without an increased hypoglycemic risk. This impact of PBM may be related to its effects on the beta cells and islets in the pancreas. Notwithstanding challenges, PBM emerges as a promising adjunctive therapy for managing diabetic neuropathy, wound healing, and glycemic control. Further investigation into its impact on diabetic retinopathy and muscle recovery is warranted.
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Affiliation(s)
- Quentin Perrier
- Univ. Grenoble Alpes, INSERM U1055, Pharmacy Department, Grenoble Alpes University Hospital, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
| | - Cécile Moro
- Univ. Grenoble Alpes, CEA-Leti, Clinatec, Grenoble, France
| | - Sandrine Lablanche
- Univ. Grenoble Alpes, INSERM U1055, Diabetology and Endocrinology Department, Grenoble Alpes University Hospital, Laboratory of Fundamental and Applied Bioenergetics, Grenoble, France
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Sharma S, Kalia V. Effect of tibial nerve mobilization on balance & gait functions in subjects with subclinical diabetic neuropathy: A randomized clinical trial. J Diabetes Metab Disord 2023; 22:1283-1290. [PMID: 37975109 PMCID: PMC10638326 DOI: 10.1007/s40200-023-01246-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 06/04/2023] [Indexed: 11/19/2023]
Abstract
Introduction With advancing age, balance control diminishes as a result of cognitive impairment, decreased muscle strength, and impairment in visual, vestibular, and somatosensory systems. Besides aforesaid factors, the addition of diabetes to all these leads to balance and gait-related issues such as falls and fall-related injuries. Impaired balance and gait performance in diabetics are primarily attributed to the diminished sensory function of the foot and ankle region owing to diabetic neuropathy. The purpose of this study was to explicitly examine the impact of neural mobilization on the balance & gait functions of subjects having subclinical diabetic neuropathy. Methods 40 individuals with subclinical diabetic neuropathy, ranging in age from 50 to 75 years, were assigned to two groups at random: Group 1 received the concurrent application of Tibial nerve mobilization and Balance-Gait training whereas Group 2 received only Balance-Gait training. The therapy was administered five times each week, for four weeks. On the first and last day of treatment, measurements of VPT, BBS, TUG, and DGI were taken from each subject. Results The results of the study found that post neural mobilization and Balance-Gait training, scores of VPT, BBS, DGI, and TUG showed improvement but it was not significant. As it is evident that diabetic neuropathy is progressive in nature, even small changes can be helpful. Conclusion Neural mobilization integrated with balance-gait training of subclinical diabetic neuropathic individuals resulted in improved sensory functions along with enhanced balance-gait functions. Supplementary Information The online version contains supplementary material available at 10.1007/s40200-023-01246-w.
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Affiliation(s)
- Shanika Sharma
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001 India
| | - Varun Kalia
- Department of Physiotherapy, Lovely Professional University, Jalandhar-Delhi, Grand Trunk Road, Phagwara, 144001 India
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3
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Preston FG, Riley DR, Azmi S, Alam U. Painful Diabetic Peripheral Neuropathy: Practical Guidance and Challenges for Clinical Management. Diabetes Metab Syndr Obes 2023; 16:1595-1612. [PMID: 37288250 PMCID: PMC10243347 DOI: 10.2147/dmso.s370050] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 05/16/2023] [Indexed: 06/09/2023] Open
Abstract
Painful diabetic peripheral neuropathy (PDPN) is present in nearly a quarter of people with diabetes. It is estimated to affect over 100 million people worldwide. PDPN is associated with impaired daily functioning, depression, sleep disturbance, financial instability, and a decreased quality of life. Despite its high prevalence and significant health burden, it remains an underdiagnosed and undertreated condition. PDPN is a complex pain phenomenon with the experience of pain associated with and exacerbated by poor sleep and low mood. A holistic approach to patient-centred care alongside the pharmacological therapy is required to maximise benefit. A key treatment challenge is managing patient expectation, as a good outcome from treatment is defined as a reduction in pain of 30-50%, with a complete pain-free outcome being rare. The future for the treatment of PDPN holds promise, despite a 20-year void in the licensing of new analgesic agents for neuropathic pain. There are over 50 new molecular entities reaching clinical development and several demonstrating benefit in early-stage clinical trials. We review the current approaches to its diagnosis, the tools, and questionnaires available to clinicians, international guidance on PDPN management, and existing pharmacological and non-pharmacological treatment options. We synthesise evidence and the guidance from the American Association of Clinical Endocrinology, American Academy of Neurology, American Diabetes Association, Diabetes Canada, German Diabetes Association, and the International Diabetes Federation into a practical guide to the treatment of PDPN and highlight the need for future research into mechanistic-based treatments in order to prioritise the development of personalised medicine.
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Affiliation(s)
- Frank G Preston
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK
| | - David R Riley
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK
| | - Shazli Azmi
- Institute of Cardiovascular Science, University of Manchester and Manchester Diabetes Centre, Manchester Foundation Trust, Manchester, UK
| | - Uazman Alam
- Department of Cardiovascular & Metabolic Medicine, Institute of Life Course and Medical Sciences and the Pain Research Institute, University of Liverpool, Liverpool, UK
- Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool University Hospital NHS Foundation Trust, Liverpool, UK
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Gbiri CAO, Iyiola HO, Usman JS, Adeagbo CA, Ileyemi BL, Onuegbu NF, Odidika FBO. Development and Comparative Efficacy of Lagos Neuropathy Protocol for Improving Recovery of Symptom and Functional Independence Performance in Individuals with Diabetic Peripheral Sensorimotor Polyneuropathy. Phys Ther Res 2021; 24:136-144. [PMID: 34532209 PMCID: PMC8419594 DOI: 10.1298/ptr.e10070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Accepted: 12/16/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Diabetic peripheral sensorimotor polyneuropathy (DPSP) has been treated with sketchy outcomes and available approaches are not applicable for self-administration. This study developed protocol for managing symptoms of DPSP and assessed its comparative efficacy. METHODS Study developed Lagos Neuropathy Protocol (LNP) through existing concept in DPSP and tested its safety, clinical applicability, and ease of self-administration. Its efficacy was compared with Buerger-Allen Exercise (BAE) by involving 31(11males) with DPSP, randomized into LNP and BAE and treated for 10-week. Toronto Clinical Scoring System was used to diagnose DPSP while Diabetic Neuropathy Examination was used to diagnose distal polyneuropathy. Sensory/pressure perception was assessed using 10 g-monofilament while Short Physical Performance Battery, Bergs Balance Scale and Visual Analogue Scale was used to assess functional performance, strength and balance, and pain respectively. RESULTS LNP has three domains: sensory/pressure/proprioception, strength/balance, and pain/swelling. Most (80%) of the participants rated the LNP as excellently safe while the rest (20%) rated as very good in safety. All the participants rated LNP excellent in terms of self-administration and suitability for clinical use without adverse effect. The mean age of the participants for the comparative phase was 66.20±9.48years while their length of diagnoses of diabetes was 15.80±13.35years. About a third (32.5%) had DPSP. Both LNP and BAE had significant improvement (p<0.05) in sensory/pressure perception, pain, strength and balance, and functional performance but LNP had better significant improvement. CONCLUSION LNP is safe, good for self-administration, clinically applicable and efficacious in improving sensory/pressure perception, balance, pain and functional performances in individuals with DPSP.
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Affiliation(s)
- Caleb Ademola Omuwa Gbiri
- Stroke and Nervous System Disorders Research Unit Group, Neurophysiotherapy Unit, Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
- Stroke and Nervous System Disorders Foundation, Lagos, Nigeria
| | - Hammed Olaoye Iyiola
- Physiotherapist, Department of Physiotherapy, Federal Medical Centre, Abeokuta, Nigeria
| | - Jibrin Sammani Usman
- Stroke and Nervous System Disorders Research Unit Group, Neurophysiotherapy Unit, Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
- Department of Physiotherapy, College of Health Sciences, Bayero University Kano, Nigeria
| | - Caleb Adewumi Adeagbo
- Stroke and Nervous System Disorders Research Unit Group, Neurophysiotherapy Unit, Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
| | - Babatunde Lekan Ileyemi
- Stroke and Nervous System Disorders Research Unit Group, Neurophysiotherapy Unit, Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
| | - Ngozi Florence Onuegbu
- Stroke and Nervous System Disorders Research Unit Group, Neurophysiotherapy Unit, Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
- Research Directorate, Medical Rehabilitation Therapists (Registration) Board of Nigeria, Nigeria
| | - Francis-Beloved Odinakachukwu Odidika
- Stroke and Nervous System Disorders Research Unit Group, Neurophysiotherapy Unit, Department of Physiotherapy, College of Medicine, University of Lagos, Nigeria
- Codas Neurorehabilitation Hospital, Lagos, Nigeria
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Toloza-Cano DC, Zequera M, González GHC. Characterization of the anteroposterior center of pressure in upright position in type 2 diabetics with peripheral diabetic neuropathy and paired healthy controls. Biocybern Biomed Eng 2021. [DOI: 10.1016/j.bbe.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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ERNANDES RITADECÁSSIA, BRECH GUILHERMECARLOS, LUNA NATÁLIAMARIANASILVA, BEGA ARMANDO, GUIMARÃES DANIELLESERRA, BOCALINI DANILOSALES, SCHERRER JÚNIOR GERSON, GREVE JULIAMARIAD, LEME LUIZEUGÊNIOGARCEZ, ALONSO ANGÉLICACASTILHO. IMPACT OF DIABETIC NEUROPATHY ON QUALITY OF LIFE AND POSTURAL BALANCE IN BRAZILIAN OLDER ADULTS. ACTA ORTOPEDICA BRASILEIRA 2020; 28:275-279. [PMID: 33328782 PMCID: PMC7723388 DOI: 10.1590/1413-785220202806234529] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To analyze the impact of the Peripheral Diabetic Neuropathy (PDN) on the postural and functional balance and quality of life of Brazilian older adults. METHODS A cross-sectional study. Sixty older men and women (60-79 years) were divided into three groups: control, DM without and with PDN. The following parameters were evaluated: anthropometry; quality of life; postural balance (BESTest); functional balance in force plate (NeuroCom Balance). RESULTS PDN group presented significant differences compared with the other groups, with the worst performance in quality of life than DM2 without PDN in: sensory functioning (p = 0.030); past and future (p = 0.036); death and dying (p = 0.035). Postural balance deficit in the total score (p = 0.025) and biomedical constraints section (p = 0.043) of the BESTest, compared with DM2 without PDN (p = 0.007). In the functional balance (Neurocom), PDN group presented a worse performance in the time spent on the left side (p = 0.030) than the control group. During step up over test, the control group performed the task faster than the group with PDN (p = 0.004). CONCLUSION This study showed that neuropaths presented worse physical performance and postural balance deficits, sensorial limitations, affecting the daily tasks and, as a consequence, decreasing the quality of life in Brazilian older adults. Level of Evidence II, Cross-sectional observational study.
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Abstract
Peripheral neuropathy (PN) is a common neurological problem defined as a dysfunction of sensory, motor, and autonomic nerves. The presence of peripheral neuropathy has recently been noticed in Parkinson's disease (PD) This comorbidity is concerning as it increases the burden on patients whose motor functions are previously compromised. A comprehensive computer-based literature review utilizing multiple peer-reviewed databases (e.g., Embase, PsycINFO, CINAHL, etc.) was conducted. There is evidence for the utility of robust diagnostic criteria to distinguish between large fiber neuropathy (LFN) and small fiber neuropathy (SFN). Some studies have established links between prolonged L-DOPA exposure and prevalence with increased levels of homocysteine (HCY) and methylmalonic acid (MMA) as pathological underlying mechanisms. PN in PD patients with relatively truncated exposure to L-DOPA therapy may have underlying mutations in the Parkin and MHTFR gene or separate mitochondrial disorders. Vitamin B12 and cobalamin deficiencies have also been implicated as drivers of PN. Accumulation of phosphorylated α-synuclein is another central feature in PN and deems urgent exploration via large cohort studies. Importantly, these underlying mechanisms have been linked to peripheral denervation. This review delves into the potential treatments for PN targeting B12 deficiencies and the use of COMT inhibitors along with other novel approaches. Avenues of research with powerful randomized controlled and long-term cohort studies exploring genetic mechanisms and novel treatment pathways is urgently required to alleviate the burden of disease exerted by PN on PD.
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Sofra X, Lampe N. A Randomized Longitudinal Double-Blind Clinical Trial on Long-Term Neuropathic Symptomatology Relief & Pain Analgesia. Health (London) 2020. [DOI: 10.4236/health.2020.127054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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9
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Decreased plasma neuregulin 4 levels are associated with peripheral neuropathy in Chinese patients with newly diagnosed type 2 diabetes: A cross-sectional study. Cytokine 2019; 113:356-364. [DOI: 10.1016/j.cyto.2018.10.007] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Revised: 09/24/2018] [Accepted: 10/05/2018] [Indexed: 12/11/2022]
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Sanderson TH, Wider JM, Lee I, Reynolds CA, Liu J, Lepore B, Tousignant R, Bukowski MJ, Johnston H, Fite A, Raghunayakula S, Kamholz J, Grossman LI, Przyklenk K, Hüttemann M. Inhibitory modulation of cytochrome c oxidase activity with specific near-infrared light wavelengths attenuates brain ischemia/reperfusion injury. Sci Rep 2018; 8:3481. [PMID: 29472564 PMCID: PMC5823933 DOI: 10.1038/s41598-018-21869-x] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 02/13/2018] [Indexed: 12/17/2022] Open
Abstract
The interaction of light with biological tissue has been successfully utilized for multiple therapeutic purposes. Previous studies have suggested that near infrared light (NIR) enhances the activity of mitochondria by increasing cytochrome c oxidase (COX) activity, which we confirmed for 810 nm NIR. In contrast, scanning the NIR spectrum between 700 nm and 1000 nm revealed two NIR wavelengths (750 nm and 950 nm) that reduced the activity of isolated COX. COX-inhibitory wavelengths reduced mitochondrial respiration, reduced the mitochondrial membrane potential (ΔΨm), attenuated mitochondrial superoxide production, and attenuated neuronal death following oxygen glucose deprivation, whereas NIR that activates COX provided no benefit. We evaluated COX-inhibitory NIR as a potential therapy for cerebral reperfusion injury using a rat model of global brain ischemia. Untreated animals demonstrated an 86% loss of neurons in the CA1 hippocampus post-reperfusion whereas inhibitory NIR groups were robustly protected, with neuronal loss ranging from 11% to 35%. Moreover, neurologic function, assessed by radial arm maze performance, was preserved at control levels in rats treated with a combination of both COX-inhibitory NIR wavelengths. Taken together, our data suggest that COX-inhibitory NIR may be a viable non-pharmacologic and noninvasive therapy for the treatment of cerebral reperfusion injury.
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Affiliation(s)
- Thomas H Sanderson
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA. .,Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA. .,Department of Molecular and Integrative Physiology, University of Michigan Medical School, Ann Arbor, MI, 48109, USA. .,Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
| | - Joseph M Wider
- Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA.,Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Icksoo Lee
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,College of Medicine, Dankook University, Cheonan-si, Chungcheongnam-do, 31116, Republic of Korea
| | - Christian A Reynolds
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Jenney Liu
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Bradley Lepore
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Reneé Tousignant
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Melissa J Bukowski
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Hollie Johnston
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Alemu Fite
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Sarita Raghunayakula
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Emergency Medicine, University of Michigan Medical School, Ann Arbor, MI, 48109, USA
| | - John Kamholz
- Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Lawrence I Grossman
- Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Karin Przyklenk
- Department of Emergency Medicine, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA.,Department of Physiology, Wayne State University School of Medicine, Detroit, MI, 48201, USA
| | - Maik Hüttemann
- Cardiovascular Research Institute, Wayne State University School of Medicine, Detroit, MI, 48201, USA. .,Center for Molecular Medicine and Genetics, Wayne State University School of Medicine, Detroit, MI, 48201, USA.
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Lin X, Xu L, Zhao D, Luo Z, Pan S. Correlation between serum uric acid and diabetic peripheral neuropathy in T2DM patients. J Neurol Sci 2017; 385:78-82. [PMID: 29406919 DOI: 10.1016/j.jns.2017.11.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 11/05/2017] [Accepted: 11/26/2017] [Indexed: 01/25/2023]
Abstract
AIM To investigate the correlation between serum uric acid (SUA) and diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) patients. METHODS Two hundred T2DM patients were divided into four groups at the cut-off points of 5, 7, and 9mg/dL of SUA levels. Nerve conduction studies (NCS), Semmes-Weinstein monofilament testing (SWMT), and vibration perception threshold (VPT) tests were performed on these patients. RESULTS Significant differences in motor/sensory nerve amplitude and conduction velocity (CV) parameters among different SUA level groups were observed (all P<0.05). SUA levels were negatively correlated with the means of motor/sensory nerve amplitude and CV (all P<0.05). Duration of T2DM >10years, SUA >9mg/dL and total cholesterol (TC) >5.2mmol/L were found to be significantly associated with DPN (all P<0.05). Receiver-operating characteristic (ROC) analysis revealed that the cut-off points of T2DM duration combined with SUA and TC were 9years, 7.8mg/dL, and 4.97mmol/L, respectively (AUC=0.65; 95% CI: 0.53-0.77; sensitivity, 70.6%; specificity, 65.2%, P=0.009). CONCLUSION There is a significant association between elevated SUA levels and DPN, and T2DM duration, SUA, and TC may be valuable indicators to predict the occurrence of DPN in T2DM patients.
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Affiliation(s)
- Xiaopu Lin
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Lingling Xu
- Department of Endocrinology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Deqiang Zhao
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Zhiyin Luo
- Department of Huiqiao Building, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China
| | - Suyue Pan
- Department of Neurology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong 510515, China.
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Rahemi H, Armstrong DG, Enriquez A, Owl J, Talal TK, Najafi B. Lace Up for Healthy Feet: The Impact of Shoe Closure on Plantar Stress Response. J Diabetes Sci Technol 2017; 11:678-684. [PMID: 28420258 PMCID: PMC5588842 DOI: 10.1177/1932296817703669] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE This study examined the impact of shoe closure on plantar thermal stress response (TSR), which is known to be a surrogate of shear stress and skin perfusion. It is aimed to explore potential impact of shoe closure on increasing risk factors associated with plantar ulcers in people with diabetic peripheral neuropathy (DPN). METHODS Fifteen eligible subjects were enrolled. The left foot was used as a reference and fitted to a self-adjusted and habitual lace-tightening method by each subject. The right foot was used as a test closure and fitted into three lace closure conditions: loose, tight, and preset optimal closure (reel clutch, BOA technology). Thermal images were taken after 5 minutes of acclimatization (pre-trial) and immediately after 200 walking steps in each shoe closure condition (post-trial). TSR was calculated from the thermal images. RESULTS TSR was significantly higher in the test closure with loose (70.24%, P = .000) and tight (66.85%, P = .007) and lower (-206.53%, P = .000) in the preset optimal closure when compared to the reference closure. Only lace closure conditions affected TSR with no significant impact from age, BMI, and gender in our sample in a multivariable regression model. CONCLUSION The results from this study suggest that shoelace closure technique can have a profound effect on TSR. It therefore stands to reason that optimal lace closure may have an impact in reducing risk of plantar ulcers in people with DPN. Interestingly, results revealed that even a self-adjusted lace closure may not be necessarily optimal and a preset closure setting like reel clutch might ultimately be recommended to minimize risk. Further study is warranted to confirm or refute these interesting results.
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Affiliation(s)
- Hadi Rahemi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, USA
| | - David G. Armstrong
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Ana Enriquez
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Joshua Owl
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona, Tucson, AZ, USA
| | - Talal K. Talal
- Diabetic Foot and Wound Clinic, Hamad Medical CO, Doha, Qatar
| | - Bijan Najafi
- Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Department of Surgery, Baylor College of Medicine, Houston, TX, USA
- Southern Arizona Limb Salvage Alliance (SALSA), Department of Surgery, University of Arizona, Tucson, AZ, USA
- Bijan Najafi, PhD, Interdisciplinary Consortium on Advanced Motion Performance (iCAMP), Michael E. DeBakey Department of Surgery, Baylor College of Medicine, One Baylor Plaza MS: BCM390, Houston, TX 77030, USA.
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Effects of monochromatic infrared phototherapy in patients with diabetic peripheral neuropathy: a systematic review and meta-analysis of randomized controlled trials. Braz J Phys Ther 2017; 21:233-243. [PMID: 28571697 PMCID: PMC5537484 DOI: 10.1016/j.bjpt.2017.05.008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2016] [Revised: 09/13/2016] [Accepted: 09/14/2016] [Indexed: 11/20/2022] Open
Abstract
MIRE is an adjunctive phototherapy source approved by FDA to improve blood perfusion and reduce pain. MIRE was associated with a modest short-term improvement in plantar tactile sensitivity, not sustained over time. MIRE resulted in a less decrease in pain relief, possibly associated with initial improvement in plantar sensitivity. Current quality of evidence is low and further studies are likely to change the estimated effect.
Background Monochromatic infrared energy (MIRE) or phototherapy has been used to improve plantar sensitivity and pain in lower limbs of patients with diabetic sensorimotor peripheral neuropathy (DSPN), but the available primary results are inconsistent. Objective To review systematically the effects of MIRE on plantar sensitivity and neuropathic pain in patients with DSPN. Methods Medline, EMBASE, Cochrane CENTRAL, and Google Scholar were searched up to September 2016. Randomized controlled trials addressing the effects of MIRE on plantar sensitivity and neuropathic pain in patients with DSPN were selected. Study inclusion, risk of bias and quality assessment, and data extraction were completed by two independent reviewers. Results Of 2549 records identified, six studies met the selection criteria, with 304 patients (594 feet) randomized. MIRE was not associated with improvement in plantar tactile sensitivity (SMD = 0.22, 95%CI −0.07 to 0.51, low quality of evidence). Subgroups of studies with short-term (up to 2 weeks) follow-up showed significant improvement in plantar sensitivity (SMD = 0.41, 95% CI 0.18–0.64). Neuropathic pain increased significantly in patients who received MIRE (MD = 0.49, 95% CI 0.30–0.68, low quality of evidence). Conclusions There was limited evidence that MIRE results in short-term improvement of tactile sensitivity probably not sustained over time. Limited evidence also suggested that MIRE does not provide relief for neuropathic pain. As quality of evidence is low, further studies are likely to change the estimated effect.
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Tütün Yümin E, Şimşek TT, Sertel M, Ankaralı H, Yumin M. The effect of foot plantar massage on balance and functional reach in patients with type II diabetes. Physiother Theory Pract 2017; 33:115-123. [DOI: 10.1080/09593985.2016.1271849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Eylem Tütün Yümin
- Abant İzzet Baysal University, School of Physical Therapy and Rehabilitation, Bolu, Turkey
| | - Tülay Tarsuslu Şimşek
- Dokuz Eylül University, School of Physical Therapy and Rehabilitation, İzmir, Turkey
| | - Meral Sertel
- Kırıkkale University, Faculty of Health Sciences, Department of Physical Therapy and Rehabilitation, Kırıkkale, Turkey
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15
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Germano AM, Schmidt D, Schlee G, Milani TL. Plantar sensory vibration thresholds are not influenced by body position. COGENT MEDICINE 2016. [DOI: 10.1080/2331205x.2016.1238600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Affiliation(s)
- Andresa M.C. Germano
- Department of Human Locomotion, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126 Chemnitz, Germany
| | - Daniel Schmidt
- Department of Human Locomotion, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126 Chemnitz, Germany
| | - Günther Schlee
- Department of Human Locomotion, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126 Chemnitz, Germany
| | - Thomas L. Milani
- Department of Human Locomotion, Chemnitz University of Technology, Reichenhainer Straße 29a, 09126 Chemnitz, Germany
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Corbett CF. Practical Management of Patients With Painful Diabetic Neuropathy. DIABETES EDUCATOR 2016; 31:523-4, 526-8, 530 passim. [PMID: 16100329 DOI: 10.1177/0145721705278800] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose Painful diabetic neuropathy (PDN) has a significant impact on patients’ quality of life, affecting sleep, mood, mobility, ability to work, interpersonal relationships, overall self-worth, and independence. The purpose of this article is to provide diabetes educators with current and essential tools for PDN assessment and management. Methods Medline and CINAHL database searches identified publications on the assessment and treatment of PDN. Identified research was evaluated, and information pertinent to diabetes educators was summarized. Results Recent advancements in assessment of neuropathic pain include identifying characteristics that distinguish between neuropathic and nonneuropathic pain. In the absence of treatment, research demonstrates that nerve damage may progress while pain diminishes. Many disease-modifying and symptom-management treatment options are available. Conclusion Good glycemic control is the first priority for both prevention and management of PDN. However, even with good glycemic control, up to 20% of patients will develop PDN. PDN recognition and assessment are critical to optimize management. Although several treatment modalities are available, few patients obtain complete pain relief. Recent advances in understanding the mechanisms underlying neuropathic pain should lead to better treatment and patient outcomes. Combination therapy, including nonpharmacologic modalities, may be required. Research evaluating the efficacy of combination therapy is needed.
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Affiliation(s)
- Cynthia F Corbett
- Intercollegiate College of Nursing, Washington State University, 2917 West Fort George Wright Drive, Spokane, Washington 99224, USA.
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Alshahrani A, Bussell M, Johnson E, Tsao B, Bahjri K. Effects of a Novel Therapeutic Intervention in Patients With Diabetic Peripheral Neuropathy. Arch Phys Med Rehabil 2016; 97:733-8. [PMID: 26808781 DOI: 10.1016/j.apmr.2015.12.026] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Revised: 12/12/2015] [Accepted: 12/22/2015] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To determine the effect of a novel therapeutic intervention called intraneural facilitation on balance measures and a neuropathy scale in patients with diabetic peripheral neuropathy. DESIGN Prospective pre- and posttest, single group clinical trial. SETTING Outpatient physical therapy clinic. PARTICIPANTS Patients with diabetic peripheral neuropathy (N=13). INTERVENTION Subjects received 10 sessions of intraneural facilitation. MAIN OUTCOME MEASURES The modified Total Neuropathy Scale, the NeuroCom SMART Balance Master system computerized dynamic posturography (CDP) that includes the Sensory Organization Test (SOT) and the limits of stability (LOS), and the Activities-specific Balance and Confidence (ABC) scale. RESULTS Subjects in this study showed significant improvement in the modified Total Neuropathy Scale, SOT, and 1 component in the LOS test (movement velocity). There were no significant differences in the ABC scale or in 4 components of the LOS test, which were reaction time, end point excursion, maximum excursion, and directional control. CONCLUSIONS Intraneural facilitation improved objective balance measures and neuropathy symptoms in patients with diabetic peripheral neuropathy. Further study is needed to determine long-term benefits of this intervention.
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Affiliation(s)
- Adel Alshahrani
- School of Allied Health Professions, Department of Physical Therapy, Loma Linda University, Loma Linda, CA
| | - Mark Bussell
- East Campus Rehabilitation Services, Department of Physical Therapy, Loma Linda University Medical Center, Loma Linda, CA
| | - Eric Johnson
- School of Allied Health Professions, Department of Physical Therapy, Loma Linda University, Loma Linda, CA.
| | - Bryan Tsao
- Clinical Neurophysiology, Neurology Department, Loma Linda University School of Medicine, Loma Linda, CA
| | - Khalid Bahjri
- School of Public Health, Department of Public Health, Loma Linda University, Loma Linda, CA
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Cg SK, Maiya AG, Hande HM, Vidyasagar S, Rao K, Rajagopal KV. Efficacy of low level laser therapy on painful diabetic peripheral neuropathy. Laser Ther 2015; 24:195-200. [PMID: 26557734 DOI: 10.5978/islsm.15-or-12] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND & AIMS Diabetic peripheral neuropathy (DPN) accounts for most common complications of T2DM. Painful DPN is associated with functional limitation & poor quality of life. Therefore, objective of the study is to find the effect of low level laser therapy on painful diabetic peripheral neuropathy (DPN) in type 2 diabetes mellitus (T2DM) Materials & methods: The study design is pre-post observational design. After obtaining ethical clearance and informed consent, 19 T2DM subjects were screened and confirmed for peripheral neuropathy in an outpatient setting with biochemical parameter, pain scale and Michigan Neuropathy Screening Instrument (MNSI). Low Level Laser therapy was irradiated through scanning mode with dosage of 3.1J/cm(2) on the plantar and dorsum of the foot and 3.4j/cm(2) with contact method for 10days and all subjects were reassessed at the end of the 10 day. Descriptive statistics and paired' test was used to analyze the pre-post finding within the group. Level of significance was set at p<0.05 RESULTS: The result analysis showed significant reduction in Pain using VAS scale (6.47 ± 0.84 to 1.21 ± 0.78 (p<0.001), MNSI (5.52 ± 1.26 to 2.71 ± 0.97 (reduction in Vibration perception threshold (32.68 ± 6.08 to 24.84 ± 4.29 (<0.001) and a significant increase in the temperature from baseline to post intervention (30.01 ± 2.11 to 31.75 ± 1.03 (p<0. 001). CONCLUSION In the present study, Low level laser therapy was found to be effective in type 2 DM with peripheral neuropathy.
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Affiliation(s)
- Shashi Kumar Cg
- Department of Physiotherapy, School of allied health sciences, Manipal University
| | - Arun G Maiya
- Department of Physiotherapy, School of allied health sciences, Manipal University
| | | | | | - Karthik Rao
- Department of General Medicine, Manipal University
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The Effect of Monochromatic Infrared Photo Energy on the Irritability of Myofascial Trigger Spot of Rabbit Skeletal Muscle. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:816956. [PMID: 26442122 PMCID: PMC4579306 DOI: 10.1155/2015/816956] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 07/15/2015] [Accepted: 08/20/2015] [Indexed: 11/19/2022]
Abstract
Objective. To determine whether the vasodilatation effect of monochromatic infrared photo energy (MIRE) had the potential for the treatment of myofascial trigger spot (MTrS) in rabbits. Design. A randomized-controlled animal study. Subjects. Twelve adult New Zealand rabbits. Methods. For each rabbit, a MTrS (equivalent to a myofascial trigger point in humans) in one side of the biceps femoris muscle was randomly selected for MIRE treatment (experimental side), while another MTrS in the other side (control side) received a sham treatment. The intervention consisted of a daily 40 minutes treatment, three times per week for 2 weeks. The prevalence of endplate noise (EPN) loci in the MTrS was assessed before, immediately after, and one week after the completion of the 2-week treatment. Results. MIRE could suppress the prevalence of EPN in the MTrS. The degree of reduction in EPN prevalence in the MTrS between the experimental side and the control side was significantly different immediately after MIRE treatment, but not significantly different one week after MIRE treatment. Conclusion. Our study suggests that MIRE may be a useful therapeutic option for the management of the myofascial trigger point in humans.
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Silva P, Figueredo Borges Botelho PF, de Oliveira Guirro EC, Vaz MMO, de Abreu DCC. Long-term benefits of somatosensory training to improve balance of elderly with diabetes mellitus. J Bodyw Mov Ther 2015; 19:453-7. [DOI: 10.1016/j.jbmt.2014.11.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 10/22/2014] [Accepted: 11/03/2014] [Indexed: 11/27/2022]
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Lee YF, Lin CC, Cheng JS, Chen GS. High-intensity focused ultrasound attenuates neural responses of sciatic nerves isolated from normal or neuropathic rats. ULTRASOUND IN MEDICINE & BIOLOGY 2015; 41:132-142. [PMID: 25438842 DOI: 10.1016/j.ultrasmedbio.2014.08.014] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/02/2014] [Revised: 08/08/2014] [Accepted: 08/12/2014] [Indexed: 06/04/2023]
Abstract
Patients with diabetic neuropathy often have neuropathic pain. The purpose of our work was to investigate the effects of high-intensity focused ultrasound (HIFU) on the conduction block of normal and neuropathic nerves for soothing pain. Adult male Sprague-Dawley rats were used, and diabetes was induced by streptozotocin injection. Diabetic neuropathy was evaluated with animal behavior tests. Sciatic nerves of both control and neuropathic rats were dissected from the starting point of the sciatic nerve to the point where the sural nerve ends near the ankle. The nerves were stored in Ringer's solution. The in vitro nerve was placed on a self-developed experimental platform for HIFU exposure. Stimulation and recording of the compound action potentials (CAPs) and sensory action potentials (SAPs) were performed. Control and neuropathic nerves exposed or not exposed to HIFU were submitted to histologic analysis. For the control and neuropathic nerves, suppression of CAPs and SAPs started 2 min post-HIFU treatment. Maximum suppression of SAPs was 34.4 ± 3.2% for the control rats and 11.6 ± 2.0% and 9.8 ± 3.0% for rats 4 wk post-injection and 8 wk post-injection, respectively. Time to full recovery was 25, 70 and 80 min, respectively. Histologic analysis revealed that the nerves in which CAPs and SAPs did not fully recover were damaged thermally or mechanically by HIFU. It is feasible to reversibly block nerves with appropriate HIFU treatment. Diabetic nerves were less suppressed by HIFU and were more vulnerable to permanent damage.
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Affiliation(s)
- Yee-Fun Lee
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Chou-Ching Lin
- Department of Neurology, National Cheng Kung University Hospital, Tainan, Taiwan
| | - Jung-Sung Cheng
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan
| | - Gin-Shin Chen
- Institute of Biomedical Engineering and Nanomedicine, National Health Research Institutes, Zhunan, Taiwan.
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Abstract
There is now little doubt that poor blood glucose control is an important risk factor for the development of diabetic peripheral neuropathy (DPN). Furthermore, traditional cardiovascular risk factors for macrovascular disease appear to be associated with an increased risk of DPN. The recently established International Expert Group on Diabetic Neuropathy has recommended new criteria for the diagnosis of DPN in the context of clinical and research settings. Studies in experimental diabetes examining the pathogenesis of DPN have identified a number of metabolic abnormalities including polyol pathway hyperactivity, increased advanced glycation end‐point formation, alterations in the protein kinase C beta pathway through diacylglycerol and oxidative stress. There is now strong evidence implicating nerve ischemia as the cause of DPN. Studies in human and animal models have shown reduced nerve perfusion and endoneurial hypoxia. These endoneurial microvascular changes strongly correlate with clinical severity and the degree of nerve‐fiber pathology. Unfortunately, many compounds that have been effective in animal models of neuropathy have not been successful in human diabetic neuropathy. The only compounds found to be efficacious in human diabetic neuropathy, and are in clinical use, are the anti‐oxidant, α‐lipoic acid and the aldose reductase inhibitor, epalrestat. Overall, the evidence emphasizes the importance of vascular dysfunction, driven by metabolic change, in the etiology of DPN, and highlights potential therapeutic approaches. Epidemiological data on diabetic painful neuropathic pain (DPNP) are limited. In one population‐based study, the prevalence of DPNP, as assessed by a structured questionnaire and examination, was estimated at 16%. It was notable that, of these patients, 12.5% had never reported symptoms to their doctor and 39% had never received treatment for their pain. Thus, despite being common, DPNP continues to be underdiagnosed and undertreated. Pharmacological treatment of DPNP include tricyclic compounds, serotonin noradrenalin reuptake inhibitors, the anti‐oxidant α‐lipoic acid, anticonvulsants, opiates, membrane stabilizers, topical capsaicin and so on. Management of the patient with DPNP must be tailored to individual requirements and will depend on the presence of other comorbidities. (J Diabetes Invest, doi: 10.1111/j.2040‐1124.2010.00083.x)
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Mikaili P, Moloudizargari M, Aghajanshakeri S. Treatment with topical nitroglycerine may promote the healing process of diabetic foot ulcers. Med Hypotheses 2014; 83:172-4. [PMID: 24880867 DOI: 10.1016/j.mehy.2014.05.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2013] [Revised: 05/06/2014] [Accepted: 05/10/2014] [Indexed: 11/30/2022]
Abstract
Diabetes mellitus is one of the main problems of the health care systems of all societies. A vast number of diabetic patients suffer from diabetic foot ulcers (DFUs) some of which may lead to the amputation of the organ(s). Nitric oxide (NO) is an indigenous gas that is produced at various sites in the body and has been shown to possess important roles in wound healing. Previous studies have shown that not only is the production of NO decreased in diabetic patients but also the sensitivity of the cells of such patients to NO is dramatically reduced. Nitroglycerine (isosorbide dinitrate) can be employed as an effective donor of NO to diabetic wounds. On such a basis, we suggest a novel hypothesis that delivery of compensatory amounts of NO to the ulcers by the administration of topical nitroglycerine enhances blood flow and biochemical activity of the ulcers and thus promotes wound healing.
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Affiliation(s)
- Peyman Mikaili
- Department of Pharmacology, Faculty of Pharmacy, Urmia University of Medical Sciences, Urmia, Iran
| | - Milad Moloudizargari
- Student of Veterinary Medicine, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran.
| | - Shahin Aghajanshakeri
- Student of Veterinary Medicine, Faculty of Veterinary Medicine, Urmia University, Urmia, Iran
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25
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Abstract
BACKGROUND Chinese herbal medicine is frequently used for treating diabetic peripheral neuropathy in China. Many controlled trials have been undertaken to investigate its efficacy.This is an update of a Cochrane review that was first published in the year 2011. OBJECTIVES To assess the beneficial effects and harms of Chinese herbal medicine for people with diabetic peripheral neuropathy. SEARCH METHODS On 14 May 2012, we searched the Cochrane Neuromuscular Disease Group Specialized Register CENTRAL (2012, Issue 4 in The Cochrane Library), MEDLINE (January 1966 to May 2012), EMBASE (January 1980 to May 2012), AMED (January 1985 to May 2012) and in October 2012, the Chinese Biomedical Database (CBM) (1979 to October 2012), Chinese National Knowledge Infrastructure Database (CNKI) (1979 to October 2012), and VIP Chinese Science and Technique Journals Database (1989 to October 2012). We searched for unpublished literature in the Chinese Conference Papers Database, and Chinese Dissertation Database (from inception to October 2012). There were no language or publication restrictions. SELECTION CRITERIA We included randomised controlled trials of Chinese herbal medicine (with a minimum of four weeks treatment duration) for people with diabetic peripheral neuropathy compared with placebo, no intervention, or conventional interventions. Trials of herbal medicine plus a conventional drug versus the drug alone were also included. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and evaluated trial quality. We contacted study authors for additional information. MAIN RESULTS Forty-nine randomised trials involving 3639 participants were included. All trials were conducted and published in China. Thirty-eight different herbal medicines were tested in these trials, including four single herbs (extracts from a single herb), eight traditional Chinese patent medicines, and 26 self concocted Chinese herbal compound prescriptions. The trials reported on global symptom improvement (including improvement in numbness or pain) and changes in nerve conduction velocity. The positive results described from the 49 studies of low quality are of questionable significance. There was inadequate reporting on adverse events in the included trials. Eighteen trials found no adverse events. Two trials reported adverse events: adverse events occurred in the control group in one trial, and in the other it was unclear in which group the adverse events occurred. 29 trials did not mention whether they monitored adverse events. Conclusions cannot be drawn from this review about the safety of herbal medicines, due to inadequate reporting. Most of the trials were of very low methodological quality and therefore the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating diabetic peripheral neuropathy should be made with caution. AUTHORS' CONCLUSIONS Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for diabetic peripheral neuropathy. No well-designed, randomised, placebo controlled trial with objective outcome measures has been conducted.
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Affiliation(s)
- Wei Chen
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Yin Zhang
- Guang'anmen Hospital, China Academy of Chinese MedicineCenter of Clinical Evaluation100053BeijingChina
| | - Xinxue Li
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Guoyan Yang
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
| | - Jian Ping Liu
- Beijing University of Chinese MedicineCentre for Evidence‐Based Chinese Medicine11 Bei San Huan Dong Lu, Chaoyang DistrictBeijingChina100029
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Li H, Nyland J, Shelton T. Effectiveness of the anodyne therapy system in treating diabetic peripheral neuropathy: a systematic review. PHYSICAL THERAPY REVIEWS 2013. [DOI: 10.1179/174328808x356429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Moore RJ, Groninger H. Chemotherapy-Induced Peripheral Neuropathy in Pediatric Cancer Patients. Cureus 2013; 5:e124. [PMID: 25144779 PMCID: PMC4094363 DOI: 10.7759/cureus.124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Chemotherapy-induced peripheral neuropathies (CIPNs) are an increasingly common neuropathic and pain syndrome in adult and pediatric cancer patients and survivors [1-69]. However, symptoms associated with CIPNs are often undiagnosed, under-assessed, and communications problems between clinicians, family members, and patients have been observed [70-73]. Less is known about the prevalence and impact of CIPNs on pediatric cancer populations [70-71]. This article aims to provide a brief understanding of CIPNs in pediatric populations, and to review the evidence for both its prevention and treatment.
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Affiliation(s)
- Rhonda J Moore
- FDA, Clinical Center, National Institutes of Health, Bethesda, MD
| | - Hunter Groninger
- FDA, Clinical Center, National Institutes of Health, Bethesda, MD
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Low-level laser treatment with near-infrared light increases venous nitric oxide levels acutely: a single-blind, randomized clinical trial of efficacy. Am J Phys Med Rehabil 2013; 92:151-6. [PMID: 23334615 DOI: 10.1097/phm.0b013e318269d70a] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The use of near-infrared light in the form of low-level laser therapy (LLLT) has become more popular in the treatment of a variety of conditions where increased peripheral blood flow is desired. The hypothesis behind its working mechanism is its purported ability to generate nitric oxide (NO) in the treated area. We tested the hypothesis that the efficacy of near-infrared light lies in its ability to generate NO at the treatment site. DESIGN We conducted a single-blind, placebo-controlled, randomized clinical trial to measure NO, by its metabolites nitrite and nitrate, in venous blood draining from tissue receiving LLLT. Fifteen healthy subjects received LLLT to the forearm, and blood samples were taken immediately before treatment; at 1, 5, 15, and 30 mins; as well as 15 mins after the treatment to check for NO content. RESULTS We found a significant treatment effect (F = 15.75, P = 0.003). A post hoc test showed that minutes 1, 5, and 15 were different compared with the baseline measures (P's < 0.05). The area under the treatment curve was significantly larger than the area under the sham treatment curve (t = 2.26, P = 0.037). A limitation of this study was that the data were collected from healthy subjects. CONCLUSIONS LLLT increased NO levels in venous blood draining from the treatment site in healthy subjects. The peak increase in NO occurred 5 mins into the treatment, after which it slowly waned. Further research is necessary to assess NO increases with LLLT in patients with pathologies.
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Lima KCDA, Freitas PBD. Avaliação da função manual e da força de preensão palmar máxima em indivíduos com diabetes mellitus. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000400014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O sucesso na realização de atividades manipulativas é crucial para um estilo independente. Como os diabéticos podem apresentar alterações sensoriais nas mãos, podem demonstrar alterações funcionais em tarefas manipulativas. Assim, o objetivo deste estudo foi comparar o desempenho de indivíduos diabéticos não neuropatas com o de não diabéticos em tarefas manipulativas e na capacidade de geração de força de preensão palmar máxima. Treze diabéticos sem diagnóstico de neuropatia (48,6±11,51 anos; 79,9±10,88 kg; 1,68 ±0,09 m) e 13 controles pareados por sexo e idade (48,5±10,09 anos; 76,44±11,79 kg; 1,69±0,1 m) participaram do estudo. A sensibilidade das mãos foi avaliada por meio do kit de monofilamentos Semmes-Weinstein e, em seguida, foram aplicados três testes comumente utilizados para avaliação da função manual na seguinte ordem: teste de função manual Jebsen Taylor (TFMJT), teste dos nove pinos nos buracos (9-PnB) e teste de força de preensão palmar máxima (FPmax). Os resultados do teste de sensibilidade cutânea indicaram que oito diabéticos apresentaram sensibilidade cutânea normal e cinco, alguma alteração sensorial detectável pelo monofilamento, a qual, no entanto, não os caracterizavam como neuropatas. Com relação aos testes funcionais, os resultados não indicaram qualquer diferença entre os grupos para os desempenhos nos três testes realizados (diabéticos e controles - TFMJT: 26,15±3,06 e 25,78±1,29 s; 9-PnB: 15,33±1,35 e 15,48±2,39 s; FPmax: 41,15±10,59 e 43,69±12,59 kgf). Assim, podemos concluir que indivíduos diabéticos sem neuropatia diabética periférica não apresentam qualquer alteração funcional nos membros superiores e na capacidade de gerar força de preensão palmar máxima.
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Therapeutic effects of short-term monochromatic infrared energy therapy on patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. J Orthop Sports Phys Ther 2012; 42:947-56. [PMID: 22960644 DOI: 10.2519/jospt.2012.3881] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN Randomized, double-blind, placebo-controlled study. OBJECTIVES To examine the short-term therapeutic effects of monochromatic infrared energy (MIRE) on participants with knee osteoarthritis (OA). Patients were assessed according to the International Classification of Functioning, Disability and Health. BACKGROUND MIRE is commonly used in therapy for patients with peripheral neuropathies. However, research has not focused intensively on the therapeutic effects of MIRE in patients with knee OA. METHODS This study enrolled 73 participants with knee OA. Participants received six 40-minute sessions of active or placebo MIRE treatment (890-nm wavelength; power, 6.24 W; energy density, 2.08 J/cm2/min; total energy, 83.2 J/cm2) over the knee joints for 2 weeks. International Classification of Functioning, Disability and Health-related outcomes were collected weekly over 4 weeks using the Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Chronic Pain Grade questionnaire, World Health Organization Quality of Life-brief version, and OA Quality of Life Questionnaire. Data were analyzed by repeated-measures analysis of variance. RESULTS No statistically significant differences were found for the interaction of group by time for Knee injury and Osteoarthritis Outcome Score scores, including pain, other symptoms, function in daily living, function in sport and recreation, and knee-related quality of life. Scores on the Lysholm Knee Scale, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Chronic Pain Grade questionnaire, World Health Organization Quality of Life-brief version, and OA Quality of Life Questionnaire also showed no significant differences between the 2 groups at any of the 4 follow-up assessments. CONCLUSION Short-term MIRE therapy provided no beneficial effects to body functions, activities, participation, and quality of life in patients with knee OA.
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Select exercise modalities may reverse movement dysfunction because of peripheral neuropathy. Exerc Sport Sci Rev 2012; 40:133-7. [PMID: 22653276 DOI: 10.1097/jes.0b013e31825f7483] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Peripheral neuropathy (PN) is a highly prevalent and potentially debilitating disease linked to mobility and postural control impairments and movement dysfunction in goal-directed movements. Although different exercises have produced functional improvements in PN, recent evidence indicates that exercises like Tai Chi can alter the damaged sensory system and facilitate recovery of mobility and balance, potentially reducing the reliance on other people.
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Jagdeo JR, Adams LE, Brody NI, Siegel DM. Transcranial red and near infrared light transmission in a cadaveric model. PLoS One 2012; 7:e47460. [PMID: 23077622 PMCID: PMC3471828 DOI: 10.1371/journal.pone.0047460] [Citation(s) in RCA: 114] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 09/17/2012] [Indexed: 11/30/2022] Open
Abstract
Background and Objective Low level light therapy has garnered significant interest within the past decade. The exact molecular mechanisms of how red and near infrared light result in physiologic modulation are not fully understood. Heme moieties and copper within cells are red and near infrared light photoreceptors that induce the mitochondrial respiratory chain component cytochrome C oxidase, resulting in a cascade linked to cytoprotection and cellular metabolism. The copper centers in cytochrome C oxidase have a broad absorption range that peaks around 830 nm. Several in vitro and in vivo animal and human models exist that have demonstrated the benefits of red light and near infrared light for various conditions. Clinical applications for low level light therapy are varied. One study in particular demonstrated improved durable functional outcomes status post-stroke in patients treated with near infrared low level light therapy compared to sham treatment [1]. Despite previous data suggesting the beneficial effect in treating multiple conditions, including stroke, with low level light therapy, limited data exists that measures transmission in a human model. Study Design/Materials and Methods To investigate this idea, we measured the transmission of near infrared light energy, using red light for purposes of comparison, through intact cadaver soft tissue, skull bones, and brain using a commercially available LED device at 830 nm and 633 nm. Results Our results demonstrate that near infrared measurably penetrates soft tissue, bone and brain parenchyma in the formalin preserved cadaveric model, in comparison to negligible red light transmission in the same conditions. Conclusion These findings indicate that near infrared light can penetrate formalin fixed soft tissue, bone and brain and implicate that benefits observed in clinical studies are potentially related to direct action of near infrared light on neural tissue.
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Affiliation(s)
- Jared R Jagdeo
- Department of Dermatology, State University of New York Downstate Medical Center, Brooklyn, New York, United States of America.
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He Y, Yip SL, Cheung KK, Huang L, Wang S, Cheing GL. The effect of monochromatic infrared energy on diabetic wound healing. Int Wound J 2012; 10:645-52. [PMID: 22776615 DOI: 10.1111/j.1742-481x.2012.01039.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
This study examined the effect of monochromatic infrared energy (MIRE) on diabetic wound healing. Fifteen diabetic rats were given MIRE intervention on their skin wounds located on the dorsum and compared with 15 control diabetic rats. Assessments were conducted for each group at weeks 1, 2 and 4 post wounding (five rats at each time point) by calculating the percentage of wound closures (WCs) and performing histological and immunohistochemical staining on sections of wound tissue. Evaluations of WCs and histological examinations of reepithelialisation, cellular content and granulation tissue formation showed no significant difference between the MIRE and the control group at each time point. Through semi-quantitative immunohistochemical staining, the deposition of type I collagen in the MIRE group was found to have improved when compared with the control group at the end of week 2 (P = 0.05). No significant differences in the myofibroblast population were detected between the two groups. In conclusion, MIRE appeared to promote collagen deposition in the early stage of wound healing in diabetic rats, but the overall wound healing in the MIRE group was not significantly different from that of the control group.
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Affiliation(s)
- Yayi He
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), China
| | - Selina Ly Yip
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), ChinaDepartment of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, ChinaDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), ChinaDepartment of Physiology and Pathophysiology, Medical School of Xi'an Jiaotong University, Xi'an, China
| | - Kwok-Kuen Cheung
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), ChinaDepartment of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, ChinaDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), ChinaDepartment of Physiology and Pathophysiology, Medical School of Xi'an Jiaotong University, Xi'an, China
| | - Lin Huang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), ChinaDepartment of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, ChinaDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), ChinaDepartment of Physiology and Pathophysiology, Medical School of Xi'an Jiaotong University, Xi'an, China
| | - Shijie Wang
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), ChinaDepartment of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, ChinaDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), ChinaDepartment of Physiology and Pathophysiology, Medical School of Xi'an Jiaotong University, Xi'an, China
| | - Gladys Ly Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong (SAR), ChinaDepartment of Endocrinology, First Affiliated Hospital of Xi'an Jiaotong University College of Medicine, Xi'an, ChinaDivision of Plastic, Reconstructive and Aesthetic Surgery, Department of Surgery, The Chinese University of Hong Kong, Prince of Wales Hospital, Hong Kong (SAR), ChinaDepartment of Physiology and Pathophysiology, Medical School of Xi'an Jiaotong University, Xi'an, China
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Local and systemic cardiovascular effects from monochromatic infrared therapy in patients with knee osteoarthritis: a double-blind, randomized, placebo-controlled study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2012; 2012:583016. [PMID: 22792125 PMCID: PMC3391934 DOI: 10.1155/2012/583016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Revised: 04/27/2012] [Accepted: 04/27/2012] [Indexed: 11/24/2022]
Abstract
Infrared (IR) therapy is used for pain relief in patients with knee osteoarthritis (OA). However, IR's effects on the cardiovascular system remain uncertain. Therefore, we investigated the local and systemic cardiovascular effects of monochromatic IR therapy on patients with knee OA in a double-blind, randomized, placebo-controlled study. Seventy-one subjects with knee OA received one session of 40 min of active or placebo monochromatic IR treatment (with power output of 6.24 W, wavelength of 890 nm, power density of 34.7 mW/cm2 for 40 min, total energy of 41.6 J/cm2 per knee per session) over the knee joints. Heart rate, blood pressure, and knee arterial blood flow velocity were periodically assessed at the baseline, during, and after treatment. Data were analyzed by repeated-measure analysis of covariance. Compared to baseline, there were no statistically significant group x time interaction effects between the 2 groups for heart rate (P = 0.160), blood pressure (systolic blood pressure: P = 0.861; diastolic blood pressure: P = 0.757), or mean arterial blood flow velocity (P = 0.769) in follow-up assessments. The present study revealed that although there was no increase of knee arterial blood flow velocity, monochromatic IR therapy produced no detrimental systemic cardiovascular effects.
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A randomized single-blind controlled trial comparing two monochromatic near-infrared light devices: implications for tissue heating and safety. Am J Phys Med Rehabil 2012; 91:789-96. [PMID: 22660375 DOI: 10.1097/phm.0b013e31825a1937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Use of near-infrared light (NIR) is becoming more commonplace in the treatment of different pathologies; however, its safety in terms of heat generation and penetration has not been documented. The purpose of this investigation was to determine and compare skin surface and underlying tissue temperature response during and for 15 mins after a 30-min NIR application to the posterior lower leg using two different NIR devices (Anodyne and HealthLight) and one sham treatment. With this information, recommendations regarding potential adverse skin reactions, including burns, can be made. In addition, these results can serve as a reference for further studies. DESIGN This single-blind randomized controlled study used a repeated-measures design. Fifteen healthy college-age individuals randomly received 30-min treatments with two different near-infrared devices and one sham device to their lower leg. A thermistor underneath the diode and a thermocouple with temperature sensors at three depths measured the temperature at skin surface and in deep tissues, respectively, every minute during the treatment and for 15 mins posttreatment. RESULTS After 30 mins of treatment, there was a significant temperature increase between the NIR devices underneath the diodes and all tissue depths and the control. The skin temperature underneath the treatment diodes increased about 9.5°C from baseline to 40°C. There was no difference between the tissue temperature changes in response to the irradiation with the two NIR heating devices. A limitation of the study is that the entire sample was drawn from a healthy college population. CONCLUSIONS The surface and underlying tissue temperature heating produced by the two NIR devices is within limits considered safe for healthy subjects.
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Sales KLDS, Souza LAD, Cardoso VS. Equilíbrio estático de indivíduos com neuropatia periférica diabética. FISIOTERAPIA E PESQUISA 2012. [DOI: 10.1590/s1809-29502012000200006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
O diabetes mellitus (DM) é uma das enfermidades crônicas mais diagnosticadas nos últimos anos. A neuropatia diabética periférica (NP) é a complicação mais prevalente dessa doença, atingindo até 80% dos diabéticos, podendo modificar o equilíbrio. Este estudo teve por objetivo comparar o equilíbrio estático de indivíduos diabéticos neuropatas, diabéticos não neuropatas e indivíduos sem DM e averiguar a influência da visão nessa situação. Foram avaliados 30 indivíduos, divididos em três grupos diferentes: GC, 10 não diabéticos (média de idade 55,5±9,72 anos); GD: 10 diabéticos sem NP (54,4±7,76 anos); e GNP, 10 diabéticos com NP (60,4±5,35 anos). Cada indivíduo foi filmado nos planos frontal e sagital, com e sem visão, avaliado quadro a quadro no software Free Video to JPG Converter®, para a seleção dos momentos de maiores oscilações. As imagens foram quantificadas através da Biofotogrametria Computadorizada, utilizando-se o software SAPO. Os dados foram tratados estatisticamente no software Graph Pad Prism (versão 5). Os resultados evidenciam que o grupo GNP apresentou diferenças estatisticamente significantes nas amplitudes de oscilações no plano frontal e sagital, nas condições com e sem visão, quando comparado com os outros grupos (p=0,0001). Mediante os resultados, concluiu-se que a NP influencia negativamente na manutenção do equilíbrio estático, principalmente sem visão.
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Hsieh RL, Lo MT, Liao WC, Lee WC. Short-Term Effects of 890-Nanometer Radiation on Pain, Physical Activity, and Postural Stability in Patients With Knee Osteoarthritis: A Double-Blind, Randomized, Placebo-Controlled Study. Arch Phys Med Rehabil 2012; 93:757-64. [DOI: 10.1016/j.apmr.2012.01.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2011] [Revised: 01/06/2012] [Accepted: 01/06/2012] [Indexed: 10/28/2022]
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Mak MC, Cheing GL. Immediate Effects of Monochromatic Infrared Energy on Microcirculation in Healthy Subjects. Photomed Laser Surg 2012; 30:193-9. [DOI: 10.1089/pho.2011.3012] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Michael C.H. Mak
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
- Physiotherapy Department, Tuen Mun Hospital, Hong Kong SAR, China
| | - Gladys L.Y. Cheing
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Kowloon, Hong Kong SAR, China
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Yamany AA, Sayed HM. Effect of low level laser therapy on neurovascular function of diabetic peripheral neuropathy. J Adv Res 2012. [DOI: 10.1016/j.jare.2011.02.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Peripheral Neuropathy. Integr Med (Encinitas) 2012. [DOI: 10.1016/b978-1-4377-1793-8.00011-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Tesfaye S, Vileikyte L, Rayman G, Sindrup SH, Perkins BA, Baconja M, Vinik AI, Boulton AJM. Painful diabetic peripheral neuropathy: consensus recommendations on diagnosis, assessment and management. Diabetes Metab Res Rev 2011; 27:629-38. [PMID: 21695762 DOI: 10.1002/dmrr.1225] [Citation(s) in RCA: 235] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2011] [Accepted: 06/06/2011] [Indexed: 01/06/2023]
Abstract
Painful diabetic peripheral neuropathy (DPN) is common, is associated with significant reduction in quality of life and poses major treatment challenges to the practising physician. Although poor glucose control and cardiovascular risk factors have been proven to contribute to the aetiology of DPN, risk factors specific for painful DPN remain unknown. A number of instruments have been tested to assess the character, intensity and impact of painful DPN on quality of life, activities of daily living and mood. Management of the patient with DPN must be tailored to individual requirements, taking into consideration the co-morbidities and other factors. Pharmacological agents with proven efficacy for painful DPN include tricyclic anti-depressants, the selective serotonin and noradrenaline re-uptake inhibitors, anti-convulsants, opiates, membrane stabilizers, the anti-oxidant alpha-lipoic acid and topical agents including capsaicin. Current first-line therapies for painful DPN include tricyclic anti-depressants, the serotonin and noradrenaline re-uptake inhibitor duloxetine and the anti-convulsants pregabalin and gabapentin. When prescribing any of these agents, other co-morbidities and costs must be taken into account. Second-line approaches include the use of opiates such as synthetic opioid tramadol, morphine and oxycodone-controlled release. There is a limited literature with regard to combination treatment. In extreme cases of painful DPN unresponsive to pharmacotherapy, occasional use of electrical spinal cord stimulation might be indicated. There are a number of unmet needs in the therapeutic management of painful DPN. These include the need for randomized controlled trials with active comparators and data on the long-term efficacy of agents used, as most trials have lasted for less than 6 months. Finally, there is a need for appropriately designed studies to investigate non-pharmacological approaches.
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Affiliation(s)
- S Tesfaye
- Diabetes Research Unit, Royal Hallamshire Hospital and University of Sheffield, Sheffield, UK
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Ites KI, Anderson EJ, Cahill ML, Kearney JA, Post EC, Gilchrist LS. Balance Interventions for Diabetic Peripheral Neuropathy. J Geriatr Phys Ther 2011; 34:109-16. [DOI: 10.1519/jpt.0b013e318212659a] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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Abstract
BACKGROUND Chinese herbal medicine is frequently used for treating diabetic peripheral neuropathy in China. Many controlled trials have been undertaken to investigate its efficacy. OBJECTIVES To assess the beneficial effects and harms of Chinese herbal medicine for people with diabetic peripheral neuropathy. SEARCH STRATEGY We searched the Cochrane Neuromuscular Disease Group Specialized Register (15 June 2010), the Cochrane Central Register of Controlled Trials (CENTRAL) (Issue 2, 2010 in The Cochrane Library), MEDLINE (January 1966 to June 2010), EMBASE (January 1980 to June 2010), AMED (January 1985 to June 2010), Chinese Biomedical Database (CBM) (1979 to June 2010), Chinese National Knowledge Infrastructure Database (CNKI) (1979 to June 2010), and VIP Chinese Science and Technique Journals Database (1989 to June 2010). We searched for unpublished literature in the Chinese Conference Papers Database and Chinese Dissertation Database (from inception to March 2010). No language or publication restrictions were used. SELECTION CRITERIA We included randomized controlled trials of Chinese herbal medicine (with a minimum of four weeks treatment duration) for people with diabetic peripheral neuropathy compared with placebo, no intervention, or conventional interventions. Trials of herbal medicine plus a conventional drug versus the drug alone were also included. DATA COLLECTION AND ANALYSIS Two authors independently extracted data and evaluated trial quality. We contacted study authors for additional information. The data analyses were carried out using Review Manager 5.1 (Cochrane software). MAIN RESULTS Thirty-nine randomized trials involving 2890 participants were included. All trials were conducted and published in China. Thirty different herbal medicines were tested in these trials, including four single herbs (extracts from a single herb), eight traditional Chinese patent medicines, and 18 self-concocted Chinese herbal compound prescriptions. The trials reported on global symptom improvement (including improvement in numbness or pain) and changes in nerve conduction velocity. There was inadequate reporting on adverse events in the included trials. Most of the trials did not mention whether they monitored adverse effects at all. Only two trials reported adverse events: one occurred in the control group in one trial and in which group was unclear in the other trial . Conclusions cannot be drawn from this review about the safety of herbal medicines due to inadequate reporting. Most of the trials were of low methodological quality and therefore the interpretation of any positive findings for the efficacy of the included Chinese herbal medicines for treating diabetic peripheral neuropathy should be made with caution. AUTHORS' CONCLUSIONS Based on this systematic review, there is no evidence to support the objective effectiveness and safety of Chinese herbal medicines for diabetic peripheral neuropathy. No well designed, randomized placebo controlled trial with objective outcome measures has been conducted.
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Affiliation(s)
- Wei Chen
- Centre For Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, 11 Bei San Huan Dong Lu, Chaoyang District, Beijing, China, 100029
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Mitchell UH. Nondrug-related aspect of treating Ekbom disease, formerly known as restless legs syndrome. Neuropsychiatr Dis Treat 2011; 7:251-7. [PMID: 21654870 PMCID: PMC3101885 DOI: 10.2147/ndt.s19177] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2011] [Indexed: 11/23/2022] Open
Abstract
Ekbom disease (EKD), formerly known as restless legs syndrome (RLS) has affected and bothered many people over the centuries. It is one of the most prevalent neurological disorders in Europe and North-America, affecting about 10% of the population. The main characteristics are the strong urge to move, accompanied or caused by uncomfortable, sometimes even distressing, paresthesia of the legs, described as a "creeping, tugging, pulling" feeling. The symptoms often become worse as the day progresses, leading to sleep disturbances or sleep deprivation, which leads to decreased alertness and daytime functions. Numerous studies have been conducted assessing the efficacy of dopaminergic drugs, opioids, and other pharmacologic agents in alleviating EKD symptoms. However, there is also a growing body of evidence demonstrating the effectiveness of nonpharmacologic treatments including life style changes, physical activity programs, pneumatic compression, massage, near-infrared light therapy, and complementary therapies. The working mechanisms behind these alternatives are diverse. Some increase blood flow to the legs, therefore reducing tissue hypoxia; some introduce an afferent counter stimulus to the cortex and with that "close the gate" for aberrant nerve stimulations; some increase dopamine and nitric oxide and therefore augment bio-available neurotransmitters; and some generate endorphins producing an analgesic effect. The advantages of these treatments compared with pharmacologic agents include less or no side effects, no danger of augmentation, and less cost.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT, USA
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Franco LC, Souza LAF, Pessoa APDC, Pereira LV. Terapias não farmacológicas no alívio da dor neuropática diabética: uma revisão bibliográfica. ACTA PAUL ENFERM 2011. [DOI: 10.1590/s0103-21002011000200020] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
A neuropatia diabética dolorosa caracteriza-se pela dor de difícil controle. O objetivo do estudo foi analisar a produção bibliográfica a respeito das terapias não farmacológicas utilizadas no alívio dessa dor. Pesquisa bibliográfica, por meio de seis (6) fontes de dados, nos últimos 12 anos (1998 a 2010), utilizando os descritores diabetes, diabetes mellitus, neuropatia dolorosa, dor neuropática, tratamento e similares. Foram selecionados 13 artigos, que abordaram o uso de acupuntura, reike, fotoestimulação, estimulação eletromagnética neural, estimulação elétrica, terapia a laser. As terapias não farmacológicas estão sendo utilizadas com o propósito de aliviar a dor neuropática diabética, no entanto, ainda não há consenso sobre a eficiência desse tipo de tratamento na redução dessa dor. A produção de conhecimento sobre a temática é escassa, especialmente, no Brasil.
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Mitchell UH, Johnson AW, Myrer B. Comparison of two infrared devices in their effectiveness in reducing symptoms associated with RLS. Physiother Theory Pract 2010; 27:352-9. [PMID: 20950168 DOI: 10.3109/09593985.2010.502210] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This study was conducted to assess whether two kinds of near-infrared light devices, using different wavelengths and frequencies, impact symptoms associated with restless legs syndrome (RLS) differently. A recent randomized controlled study showed that symptoms associated with RLS can be diminished with near-infrared light treatment for a limited time. We wanted to assess whether different wavelengths and frequencies had an impact on its effectiveness. Twenty-five volunteers with symptoms of RLS were randomly assigned to either Anodyne® or HealthLight™ treatment. Both groups underwent 12 treatments with near-infrared light, three times a week for 4 weeks. A validated RLS rating scale was used to track changes. The two groups were not different in reported symptoms at baseline (p=0.37) and after 4 weeks of treatment (p=0.88). There was a significant improvement of symptoms between week 0 and week 4 (p<0.001); the difference in change indicated virtually the same improvement between the two groups. Although the two near-infrared light devices used different wavelengths and frequencies and one device used additional red light, they both produced significant improvement in the symptoms associated with RLS after 4 weeks of treatment.
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Affiliation(s)
- Ulrike H Mitchell
- Department of Exercise Sciences, Brigham Young University, Provo, UT 84602, USA.
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Ewing GW, Parvez SH. The multi-systemic nature of diabetes mellitus: Genotype or phenotype? NORTH AMERICAN JOURNAL OF MEDICAL SCIENCES 2010; 2:444-56. [PMID: 22558546 PMCID: PMC3339106 DOI: 10.4297/najms.2010.2444] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This article discusses factors which materially influence the diagnosis, prevention and treatment of diabetes mellitus but which may be overlooked by the prevailing biomedical paradigm. That cognition can be mathematically linked to the function of the autonomic nervous system and physiological systems casts new light upon the mechanisms responsible for homeostasis and origins of disease. In particular, it highlights the limitations of the reductionist biomedical approach which considers mainly the biochemistry of single pathologies rather than considering the neural mechanisms which regulate the function of physiological systems, and inherent visceral organs; and which are subsequently manifest as biochemistries of varying degrees of complexity and severity. As a consequence, histopathological tests are fraught with inherent limitations and many categories of drugs are significantly ineffective. AIMS Such limitations may be explained if disease (in particular diabetes mellitus) has multiple origins, is multi-systemic in nature and, depending upon the characteristics of each pathology, is influenced by genotype and/or phenotype. RESULTS This article highlights the influence of factors which are not yet considered re. the aetiology of diabetes mellitus e.g. the influence of light and sensory input upon the stability of the autonomic nervous system; the influence of raised plasma viscosity upon rates of reaction; the influence of viruses and/or of modified live viruses given in vaccinations; systemic instability, in particular the adverse influence of drinks and lack of exercise upon the body's prevailing pH and its subsequent influence upon levels of magnesium and other essential trace elements. CONCLUSIONS This application of the top-down systems biology approach may provide a plausible and inclusive explanation for the nature and occurrence of diabetes mellitus.
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Affiliation(s)
- Graham Wilfred Ewing
- Montague Healthcare, Mulberry House, 6 Vine Farm Close, Cotgrave, Nottingham NG12 3TU, United Kingdom
| | - Syed Hasan Parvez
- CNRS Neuroendocrine Unit, Institute Alfred Fessard of Neurosciences, Bât 5, Parc Chateau CNRS, 91190 Gif Sur Yvette, France
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Tavakoli M, Asghar O, Alam U, Petropoulos IN, Fadavi H, Malik RA. Novel insights on diagnosis, cause and treatment of diabetic neuropathy: focus on painful diabetic neuropathy. Ther Adv Endocrinol Metab 2010; 1:69-88. [PMID: 23148152 PMCID: PMC3475285 DOI: 10.1177/2042018810370954] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
Diabetic neuropathy is common, under or misdiagnosed, and causes substantial morbidity with increased mortality. Defining and developing sensitive diagnostic tests for diabetic neuropathy is not only key to implementing earlier interventions but also to ensure that the most appropriate endpoints are employed in clinical intervention trials. This is critical as many potentially effective therapies may never progress to the clinic, not due to a lack of therapeutic effect, but because the endpoints were not sufficiently sensitive or robust to identify benefit. Apart from improving glycaemic control, there is no licensed treatment for diabetic neuropathy, however, a number of pathogenetic pathways remain under active study. Painful diabetic neuropathy is a cause of considerable morbidity and whilst many pharmacological and nonpharmacological interventions are currently used, only two are approved by the US Food and Drug Administration. We address the important issue of the 'placebo effect' and also consider potential new pharmacological therapies as well as nonpharmacological interventions in the treatment of painful diabetic neuropathy.
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Affiliation(s)
- Mitra Tavakoli
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Omar Asghar
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Uazman Alam
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Ioannis N. Petropoulos
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Hassan Fadavi
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
| | - Rayaz A. Malik
- Mitra Tavakoli, PhD Omar Asghar, MRCP Uazman Alam, MRCP Ioannis N. Petropoulos, MSc Hassan Fadavi, MD Division of Cardiovascular Medicine, University of Manchester, Manchester, M13 9NT, UK
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Swislocki A, Orth M, Bales M, Weisshaupt J, West C, Edrington J, Cooper B, Saputo L, Islas M, Miaskowski C. A randomized clinical trial of the effectiveness of photon stimulation on pain, sensation, and quality of life in patients with diabetic peripheral neuropathy. J Pain Symptom Manage 2010; 39:88-99. [PMID: 19896325 DOI: 10.1016/j.jpainsymman.2009.05.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 05/17/2009] [Accepted: 06/17/2009] [Indexed: 01/07/2023]
Abstract
CONTEXT Peripheral neuropathy is one of the most common complications of diabetes. OBJECTIVES The purpose of this study was to evaluate the effects of photon stimulation on pain intensity, pain relief, pain qualities, sensation and quality of life (QOL) in patients with painful diabetic peripheral neuropathy. METHODS In this randomized, placebo-controlled trial, patients were assigned to receive either four photon stimulations (n=63) or four placebo (n=58) treatments. Pain intensity, pain relief, and pain qualities were assessed using self-report questionnaires. Sensation was evaluated using monofilament testing. QOL was measured using the Medical Outcomes Study Short Form-36 (SF-36). Multilevel regression model analyses were used to evaluate between-group differences in study outcomes. RESULTS No differences, over time, in any pain intensity scores (i.e., pain intensity immediately post-treatment, average pain, worst pain) or pain relief scores were found between the placebo and treatment groups. However, significant decreases, over time, were found in some pain quality scores, and significant improvements in sensation were found in patients who received the photon stimulation compared with placebo. In addition, patients in the treatment group reported significant improvements in SF-36 social functioning and mental health scores. Findings from a responder analysis demonstrated that no differences were found in the percentages of patients in the placebo and treatment groups who received 30% or more or 50% or more reduction in pain scores immediately post-treatment. However, significant differences were found in the distribution of the changes in pain relief scores, with most of the patients in the photon stimulation group reporting a slight (28.6%) to moderate (34.9%) improvement in pain relief from the beginning to the end of the study compared with no change in pain relief (43.1%) in the placebo group. CONCLUSION Four treatments with photon stimulation resulted in significant improvements in some pain qualities, sensation, and QOL outcomes in a sample of patients with a significant amount of pain and disability from their diabetes. A longer duration study is needed to further refine the photon stimulation treatment protocol in these chronically ill patients and to evaluate the sustainability of its effects.
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Affiliation(s)
- Arthur Swislocki
- Department of Medicine, Veterans Affairs Northern California Health Care System, Martinez, California, USA
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