The Comparison of Effectiveness of TENS and Placebo TENS in Peripheral Neuropathic Pain in Patients with Type II Diabetes Mellitus

Abstract

Objective: Diabetic peripheral neuropathic pain affects the functionality, mood, and sleep patterns of approximately 10 to 20 percent of patients with diabetes mellitus. Treatment goals include restoring function and improving pain control. In this study we aimed to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and placebo TENS in the treatment of peripheral neuropathic pain in patients with type II diabetes mellitus (DM). Material and Methods: Forty patients who were diagnosed as type II DM with peripheral neuropathy were enrolled to this study. Patients were randomly divided into two groups as Group A (n= 20) TENS group and Group B (n= 20) placebo TENS group. Forty-eight hours before the beginning of TENS therapy, the drugs used for the treatment of neuropathic pain were discontinued. The electrodes of the TENS were bilaterally placed on the lumbosacral region, 3 cm lateral of the vertebral column. The frequency of the electrostimulation which was used in Group A patients was 80 hertz and the amplitude was high enough to create paresthesia. No electrostimulation was given to Group B patients. TENS was applied 30 minutes daily and the procedure was continued for 20 days in both groups. Visual analog scale (VAS) scores and pain grades of the patients at certain times were taken into account for evaluating the effectiveness of the procedure. Results: The demographic data of the groups were not significantly different. Although VAS scores before procedure and on the 5th day of the procedure were not significantly different between groups (p> 0.05), VAS scores on 10th and 20th days of the procedure in Group A were significantly lower than Group B (p< 0.001). There was no significant difference between pain grades of Group A and B at the beginning of the study, but pain grades in Group A were significantly lower than Group B when evaluated at the end of the study (p< 0.001). Conclusion: Treatment of the patients with DN is a challenging for the physicians. TENS can be used as an efficient and safe treatment option especially in DN patients in whom pharmachologic treatment is contraindicated or inefficient. Placebo TENS has a limited placebo effect in diabetic neuropathy patients.