Clinical Experience of High Frequency and Low Frequency TENS in Treatment of Diabetic Neuropathic Pain in Russia

Abstract

Background: Transcutaneous electrical nerve stimulation (TENS) is presently one of the main methods of treatment for neuropathic pain in type II diabetes mellitus. The discussion about which TENS frequency is more effective in the treatment of neuropathic pain has been ongoing for many years. Despite this, the response of different aspects of neuropathic pain to various TENS modalities has not been sufficiently studied. Aim: To analyze changes in characteristics of neuropathic pain depending on the frequency of TENS. Materials and methods: Seventy-five Russian diabetic patients with painful distal axonal neuropathy were enrolled in the study. Patients were assigned to three groups: in the HF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + high-frequency TENS (HF); in the LF TENS group, 25 patients received standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin) + low-frequency TENS (LF); in the control group, 25 patients underwent just standard drug therapy (Alpha-lipoic acid, Pentoxifylline, Vitamin B12, Gabapentin). Pain intensity was calculated before and after treatment with visual analogue scale (VAS), McGill pain questionnaire (MPQ), Douleur Neuropathique 4 Questions (DN4) and Pain Drawing. Results: TENS increased the therapeutic effect of standard drug therapy, in the treatment of neuropathic pain, by 65.9% and prolonged its efficacy by 31% for up to 6 months after treatment. HF TENS had a more pronounced analgesic effect than LF TENS based on VAS (34.7%), sensory (57.6%) MPQ dimensions and DN4 (21%). Affective MPQ dimension with the use of LF TENS was lower than HF TENS by 34.7% immediately after treatment, by 47.3% after 2 months and by 34.8% after 6 months of the follow-up period. Conclusion: There are significant differences between HF and LF TENS based on pain assessment using various pain scales. This reflects the distinctive effects of different TENS modalities on different aspects of neuropathic pain.

Neuromodulation of the peripheral nervous system: Bioelectronic technology and prospective developments

“…Numerous other studies have investigated the use of TENS for managing neuropathic pain, including in conditions such as diabetic peripheral neuropathic pain and postherpetic neuralgia. [105][106][107] However, the analgesic efficacy of TENS in this context remains inconclusive, and further large-scale investigations are required to explore the stimulation conditions. Finally, TENS has also been utilized as a treatment option for overactive bladder (OAB), which is characterized by excessive bladder muscle contractions.…”

“…Moreover, the authors demonstrated that the non‐pharmacological TENS method was more effective and safer than the weak opioids commonly used as pain relievers, an important finding as safety is of significant concern when treating chronic pain. Numerous other studies have investigated the use of TENS for managing neuropathic pain, including in conditions such as diabetic peripheral neuropathic pain and postherpetic neuralgia [105–107] . However, the analgesic efficacy of TENS in this context remains inconclusive, and further large‐scale investigations are required to explore the stimulation conditions.…”

Recent topics on repetitive peripheral magnetic stimulation (rPMS) and transcutaneous electrical nerve stimulation (TENS) in clinical rehabilitation

“…They may include brain, brainstem and spinal cord. 18 Further, TENS has benefit for patients with PNP (diabetes, herpes zoster or cancer) 19 and CNP (stroke, spinal cord injury or multiple sclerosis).…”

Functional Recovery and Regenerative Effects of Direct Transcutaneous Electrical Nerve Stimulation in Treatment of Post-COVID-19 Guillain–Barré and Acute Transverse Myelitis Overlap Syndrome: A Clinical Case

“…TENS was originally intended for the treatment of pain [ 17 ]. Gradually, the effectiveness of TENS in accelerating regenerative processes and reducing neurological deficits has been proven in many clinical and experimental studies [ 18 , 19 , 20 , 21 , 22 ].…”