Diabetes, Metabolic Syndrome and Obesity (May 2023)
Treatment of Painful Diabetic Neuropathy Using Frequency Rhythmic Electro Magnetic Neural Stimulation (FREMS); Effectiveness in Daily Practice
Abstract
Ben Imholz,1 Jack Heijster,1 Abd Tahrani,2 Adriaan Kooy3 1Department of Internal Medicine, ETZ Ziekenhuis, Tilburg, the Netherlands; 2Department of Endocrinology and Diabetes, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK; 3Department of Internal Medicine, Bethesda Hospital, Treant Care Group, Hoogeveen, the NetherlandsCorrespondence: Ben Imholz, Department of Internal Medicine, ETZ-Location Waalwijk, Kasteellaan 2 5141BM Waalwijk, Tilburg, the Netherlands, Email [email protected]: Painful diabetic peripheral neuropathy (PDPN) is common and difficult to treat with limited treatment options. We assessed the efficacy of frequency rhythmic electromagnetic neural stimulation (FREMS) in patients with PDPN.Methods: An uncontrolled prospective survey of patients with PDPN and pain despite at least two lines of pharmacotherapy. The primary outcome, 50% reduction in pain scores at 1 and/or 3 months post FREMS. FREMS was applied to both legs below the knees using 4 sets of electrodes per leg; the treatment consisted of 10 sessions of 35 min applications given over 14 days. FREMS was repeated every 4 months and patients were followed up for 12 months. Pain was assessed using the neuropathic pain symptom inventory (NPSI) and quality of life (QOL) by the EQ-5D.Results: Out of 336 subjects, 248 patients met the inclusion criteria (56% men), average age and diabetes duration were 65 and 12.6 years respectively. FREMS was associated with a median decrease NPSI of 31% at M1 (range − 100;+93%), and a median decrease of − 37.5% at M3 (range − 100;+250%). The 50% reduction in pain was reached in 80/248 (32.3%) and 87/248 (35.1%) after M1 and M3 respectively. The change in NPSI was accompanied by a decrease in self reported use of opiates of > 50%.Conclusion: FREMS treatment was associated with a significant reduction in pain severity over a three months period in patients who did not have adequate response to pharmacotherapy. Randomised (sham)-controlled trials examining the role of FREMS as a treatment for PDPN in non-responders to pharmacotherapy are needed.Keywords: diabetic neuropathy, electrical stimulation, FREMS, NPSI pain score, quality of life, one-year follow-up
