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. 2022 Jul 14;32(3):10687.
doi: 10.4081/ejtm.2022.10687.

Analgesic effects of high-frequency and low-frequency TENS currents in patients with distal neuropathy

Natalia Kulikova  1 , Al-Zamil Mustafa Khalilovich  2 , Tatiana Konchugova  3 , Andrey Rachin  4 , Tinatin Chkheidze  5 , Detelina Kulchitskaya  6 , Fesyun Anatoliy  7 , Natalia P Sanina  8 , Elena Ivanova  9
Affiliations

Analgesic effects of high-frequency and low-frequency TENS currents in patients with distal neuropathy

Natalia Kulikova et al. Eur J Transl Myol. .

Abstract

Currently, diabetes mellitus (DM) is relevant problem, both for its prevalence and complications, including distal polyneuropathy (DPNP). At the same time, discussions continue on analgesic efficacy of transcutaneous electrical nerve stimulation (TENS) in DPNP. Aim of this study was to conduct a multi-faceted assessment of pain syndrome in these patients before and after TENS, taking into account levels of polyneuropathy, its severity and age of patients. The study was conducted in accordance with the research of the Federal State Budgetary Institution of the National Medical Research Center for Rehabilitation and Balneology of the Ministry of Health of the Russian Federation (CTR No. 121040100062-3) and with the permission of the Local Ethics Committee (IRB No. 2 dated 14.01.2021). The study included 75 patients with DM type II with DPNP, which are distributed into 3 groups of 25 people: Group 1a, patients received high-frequency TENS (HF); Group Ib, patients received low-frequency TENS (LF); as control, Group C received a standard method of pharmacological therapy without physiotherapy. Intensity of DPNP was evaluated before and after the course of treatment using a visual analog scale (VAS), the McGill Pain Questionnaire (MPQ), and a graphical linear analysis of pain on the neuropathic pain diagnostic questionnaire 4 (DN4) scale. TENS provides an analgesic effect that may exceed pharmacotherapy in terms of efficacy and safety. There was a 65.9% reduction in neuropathic pain according to VAS after a course of application, with the effects remaining up to 34% during the 6-month follow-up. HF TENS provided a higher significant analgesic effects than LF TENS, as it ensures the reduction of pain syndrome according to VAS by 25.8% (p <0.01), and total estimated characteristics - 35.5% (p <0.01), and touch - in at 58.1% (p = 0.001) and according to the scales of the MPQ (S) and DN4 - by 21% (p = 0.007). The observed differences in analgesic effects between HF TENS and LF TENS are based on analyses of pain in the immediate and long-term follow-up periods of type II DM patients with DPNP. These results, based on summation of the estimated parameters of the international pain scales support expectation of an expansion of the the use of analgesic TENS in aging patients suffering with DM of varying severity and extent of DPNP damage, a goal of great scientific and practical importance.

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We confirm that we have read the Journal’s position on issues involved in ethical publication and affirm that this report is consistent with those guidelines.

It has been established that neuropathic pain develops in 10-50% of patients with distal polyneuropathy (DPNP) in type II diabetes mellitus (DM). At the same time, drug therapy, as a rule, provides insufficiently high analgesic results in the treatment of patients with severe neuropathic pain, which determines the importance of optimizing analgesic measures for DPNP by non-drug methods. Previously, it was proved that the use of transcutaneous electrical nerve stimulation (TENS) provides an increase in the effectiveness of analgesic drugs in patients with type II diabetes with DPND, potentiating the regression of negative sensory dysfunction by 1.5 times and positive sensory dysfunction by 2.1 times, directly affecting the clinical manifestations of neuropathic pain. It is important to note that the use of a single visual analog scale (VAS) provides only a frontal cross-section of pain regression, excluding multi-faceted aspects of pain syndrome in patients with DM and DPNP.

The consensus recommendations of the Toronto Expert Group on Diabetic Neuropathy define TENS as an effective non-pharmacological treatment for neuropathic pain. TENS of peripheral nerves in patients with type II DM suffering with DPNP was first time applied in Russia in 2015,, which allowed us to obtain new data and new scientific concept of the mechanisms of action of TENS: i) regional improvement of blood circulation in the nerve and the surrounding tissues; ii) an increase in axonal transport, leading to accumulation of growth factor in peripheral nerves; iii) formation of anastomoses between the intact and damaged nerve fibers; iv) reinnervation of muscle fibers; v) regeneration of nerve fibers; and vi) inhibition of pro-inflammatory cytokines.

It should be noted that currently conducted clinical and experimental studies, including TENS, give a very contradictory assessment and interpretation of the results of immediate and long-term observation, both in relation to pulse modulations of high-frequency (HF TENS) and low-frequency (LF TENS) current of different shapes, as well as in terms of amplitude and frequency parameters (100-200 Hz) and (1-3 Hz).

The aim of this study was to conduct a multi-faceted assessment of pain syndrome in patients with type II DM suffering with DPNP before and after use of pulsed modulated current of different frequency and amplitude in the form of TENS, adding scientific data on the mechanism of action and developing optimizing analgesic techniques taking into account the levels and severity of polyneuropathy and age of patients based on analytical structural details of this pain syndrome.

Figures

Fig 1.
Fig 1.
Pain assessment on the DN4 scale immediately after TENS and in the long-term follow-up period.
See this image and copyright information in PMC

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References

    1. Didangelos T, Doupis J, Veves A. Painful diabetic neuropathy: clinical aspects. Handb Clin Neurol. 2014;126:53-61. doi: 10.1016/B978-0-444-53480-4.00005-9. - PubMed
    1. Al Zamil MKh. Results of a comparative analysis between percutaneous electroneurostimulation and acupuncture in the treatment of 548 patients with diabetic distal polyneuropathy of the lower extremities. Clinical Neurology. 2019; 4(1):9-17. (In Russ.).
    1. Minenko IA, Al-Zamil MKh. Dynamics of quality of life of patients with diabetic neuropathic pain syndrome against the background of complex application of percutaneous electrical nerve stimulation and acupuncture. Siberian Scientific Medical Journal. 2017; 37(5): 62-67. (In Russ.).
    1. Singh-Franco D, Jacobs RJ. Patient perspectives on peripheral neuropathic pain experience within the community. Diabetes Metab Syndr. 2017. Nov;11 Suppl 1:S243-S246. doi: 10.1016/j.dsx.2016.12.038. Epub 2016 Dec 22. - PubMed
    1. Sergeenko EYu, Romashina OM, Lobysheva AA, Zhitareva IV, Barysheva OV. Combined use of low-frequency pulse current and vacuum exposure in the rehabilitation of patients with diabetic polyneuropathy. Bulletin of Restorative Medicine. 2019; 5(93):40-46. (In Russ.).