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Electrotherapy for the treatment of painful diabetic peripheral neuropathy: a review.
Pieber K, Herceg M, Paternostro-Sluga T.
Department of Physical Medicine and Rehabilitation, Medical University of Vienna, General Hospital Vienna, Vienna, Austria.
OBJECTIVE: To review different types of electrotherapy for the treatment of painful diabetic peripheral neuropathy.
METHODS: A structured search of the electronic database MEDLINE was
performed from the time of its initiation to July 2009. Articles in
English and German were selected.
RESULTS: The efficacy of different types of electrotherapy for
painful diabetic peripheral neuropathy has been evaluated in 15 studies;
the effects of transcutaneous electrical nerve stimulation (TENS) are
consistent. The beneficial effects of prolonged use have been reported
in three large studies and one small study. The effects of
frequency-modulated electromagnetic neural stimulation were assessed in
one large study, and a significant reduction in pain was reported. Treatment
with pulsed and static electromagnetic fields has been investigated in
two small and three large studies, and analgesic benefits have been
reported. In one large study focusing on pulsed electromagnetic
fields, no beneficial effect on pain was registered. Only small studies
were found concerning other types of electrotherapy, such as
pulsed-dose electrical stimulation, high-frequency external muscle
stimulation or high-tone external muscle stimulation. The conclusions
drawn in these articles are diverse. Shortcomings and problems,
including a poor study design, were observed in some.
CONCLUSION: Further randomized, double-blind, placebo-controlled
studies comprising larger sample sizes, a longer duration of treatment,
and longer follow-up assessments are required.
Journal of Rehabilitation Medicine. April 2010. 42(4):289-95. PMID: 20461329
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Static magnetic field therapy for symptomatic diabetic neuropathy: a randomized, double-blind, placebo-controlled trial.
Weintraub MI, Wolfe GI, Barohn RA, Cole SP, Parry GJ, Hayat
G, Cohen JA, Page JC, Bromberg MB, Schwartz SL; Magnetic Research Group.
Department of Neurology, New York Medical College, Valhalla, NY, USA.
OBJECTIVE: To determine if constant wearing of multipolar,
static magnetic (450G) shoe insoles can reduce neuropathic pain and
quality of life (QOL) scores in symptomatic diabetic peripheral
neuropathy (DPN).
DESIGN: Randomized, placebo-control, parallel study.
SETTING: Forty-eight centers in 27 states.
PARTICIPANTS: Three hundred seventy-five subjects with DPN
stage II or III were randomly assigned to wear constantly magnetized
insoles for 4 months; the placebo group wore similar, unmagnetized
device.
INTERVENTION: Nerve conduction and/or quantified sensory testing were performed serially.
MAIN OUTCOME MEASURES: Daily visual analog scale scores for
numbness or tingling and burning and QOL issues were tabulated over 4
months. Secondary measures included nerve conduction changes, role of
placebo, and safety issues. Analysis of variance (ANOVA), analysis of
covariance (ANCOVA), and chi-square analysis were performed.
RESULTS: There were statistically significant reductions
during the third and fourth months in burning (mean change for magnet
treatment, -12%; for sham, -3%; P<.05, ANCOVA), numbness and tingling
(magnet, -10%; sham, +1%; P<.05, ANCOVA), and exercise-induced foot
pain (magnet, -12%; sham, -4%; P<.05, ANCOVA). For a subset of
patients with baseline severe pain, statistically significant reductions
occurred from baseline through the fourth month in numbness and
tingling (magnet, -32%; sham, -14%; P<.01, ANOVA) and foot pain
(magnet, -41%; sham, -21%; P<.01, ANOVA).
CONCLUSIONS: Static magnetic fields can penetrate up to 20mm
and appear to target the ectopic firing nociceptors in the epidermis and
dermis. Analgesic benefits were achieved over time.
Arch Phys Med Rehabil. 2003 May;84(5):736-46.
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A Double-Blind Study Demonstrating Therapeutic Benefit of Magnets In Heel Pain Symptomology
Larry Seaman, DPM
Barry University School of Podiatric Medicine, Miami, Florida
To determine the effectiveness of permanently magnetized pads
for the treatment of heel pain syndrome. A double-blind study was
performed on patients who have had symptoms in the above areas for at
least two weeks. --- Permanently magnetized and demagnetized pads will
be applied to the symptomatic feet without the patient of the clinician
able to differentiate due to identical appearing pads. Only an impartial
referee is aware of the true identity of each pad.
CHARACTERISTICS OF THE MATERIAL TO BE TESTED:
The bipolar pads to be used are rectangular and are 53 mm x
83 mm and produce about 300 gauss of magnetic current. An identical
number of factory demagnetized pads of identical dimensions were also
used for the study.
PATIENTS TO BE TESTED:
Twenty patients were initially studied using the bipolar pads
on their symptomatic feet. All patients were seen at the foot clinics
of the Barry University School of Podiatric Medicine. The age of
patients varied from age 21 to age 78. The sex of the patients was
noted, but not thought to be a significant factor in the study.
The patients tested had either heel spur or acute planter
fasciitis symptoms such as, acute, burning, or sharp pain on the heel
area. All patients had local symptoms without neurological damage to
their back or lower extremities. Patients who underwent foot surgery
within the past year were not included. Patients who had metallic
implants, such as screws or wires in their feet were excluded. All
patients underwent two weeks of therapy and two weeks of minimum
follow-up after the treatment.
CRITERIA FOR TEST DOCUMENTATION:
- Criterion A: Subjective pain sensation.
- Criterion B: Ability to ambulate without pain.
- Criterion C: Need for pain or anti-inflammatory medication.
- Criterion D: Accompanying therapy.
RESULTS OF CLINICAL TRIALS OF TWENTY PATIENTS
Criterion A: Subjective relief of symptoms.
Magnetized pads: Fourteen patients
- Excellent = 5
- Good = 3
- Fair or no better = 6
Demagnetized pads: Six patients
- Excellent = 1
- Good = 0
- Fair or no better = 5
Criterion B: Ability to ambulate without pain.
Magnetized pads: Fourteen patients
- Excellent = 7
- Good = 4
- Fair or no better = 3
Demagnetized pads: Six patients
- Excellent = 1
- Good = 1
- Fair or no better = 4
Criterion B and C = All patients in the study did not need medications or physiotherapy.
PERCENTAGE of IMPROVEMENT with MAGNETIZED PADS
- Criterion A: Subjective relief of pain = 57.2%
- Criterion B: Improvement in walking = 77.1%
- Criterion C: Need for medication = 0%
- Criterion D: Need for physiotherapy = 0%
PERCENTAGE of IMPROVEMENT with DEMAGNETIZED PADS
- Criterion A: Subjective relief of pain = 16.6%
- Criterion B: Improvement in walking = 16.6%
- Criterion C: Need for medication = 0%
- Criterion D: Need for physiotherapy = 0%
DISCUSSION OF RESULTS
The indication groups for all trial criteria showed a
significantly higher therapeutic effectiveness with the magnetized pads
than the control groups (demagnetized pads). The best results were
achieved with reduction in subjective pain in the heel spur syndrome
category. 57.2% of all test persons in this category treated with
magnetized pads expressed significant relief of symptoms.
The patients who showed increase in ability to walk without
pain after treatment represented a 77.1 % improvement rate ~with the
magnetized pads versus a 16.6% improvement reported by those with the
demagnetized pads. This percentage represented a placebo effect.
CONCLUSION
The patient group in all criteria showed a higher percentage
of favorable results with the magnetized pads than the demagnetized
pads. The application of the pads to the treatment areas produced no
side effects or skin irritation.
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Effect of magnetic insoles on postural sway measures in men and women during a static balance test.
Suomi R, Koceja DM.
School of Health, Exercise Science and Athletics, University of Wisconsin-Stevens Point 54481, USA. rsuomi@uwsp.edu
Numerous anecdotal reports have suggested a growing public
enthusiasm for magnetic devices for treatment of pain and various motor
and sensory dysfunctions. Although the principles behind magnetic
therapy are well documented, a complete technical explanation of whether
static magnet application is effective is lacking due to a paucity of
scientific research. In this study the effectiveness of magnetic insoles
on postural sway measures during a single application were
investigated. Twenty-eight adults (14 old, 14 young) were assessed on
postural sway measures while performing a static two-legged stance test
on a Kistler force platform under two treatment conditions (magnetic
insoles, nonmagnetic insoles). Significant reductions in total sway area
and lateral sway scores were obtained by the older adults while
standing on the magnetic insoles. These preliminary results indicate
that treatment of postural instability using magnetic insoles may be a
viable alternative for older adults.
Percept Mot Skills. 2001 Apr;92(2):469-76.
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Clinical evaluation of the effective use of magnetic fields in podology.
Simoncini L, Giuriati L, Giannini S.
Unita Operativa Recupero e Rieducazione Funzionale, Ospedale Maggiore, Bologna.
The use of magnetic fields in medicine has obtained
encouraging results and it has stimulated the research conducted so that
the use of this method of treatment may be better and more widespread. A
double blind study was conducted to evaluate the effectiveness of the
generation of magnetic fields on edema and on pain in patients submitted
to surgery for bilateral hallux valgus.
Chir Organi Mov. 2001 Jul-Sep;86(3):243-7.
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