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Review article

Electrotherapy for the treatment of painful diabetic peripheral neuropathy – a review

doi: 10.2340/16501977-0554

Open access


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 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.
Key words: review; electrotherapy; painful diabetic peripheral neuropathy.


Karin Pieber, Malvina Herceg, Tatjana Paternostro-Sluga


  1. Table I. Electrotherapy for the treatment of painful diabetic peripheral neuropathy



    Level of evidence




    Kumar & Marshall (26)

    Randomized, controlled



    TENS or sham treatment, 4 weeks, 30 min daily

    Transient reduction in pain and discomfort in 83% of patients

    Kumar et al. (27)

    Randomized, controlled, 2 arm


    TENS or sham treatment in combination with amitriptyline, 12 weeks, 30 min daily

    85% of patients beneficial effect, 36% asymptomatic, recurrence after termination of TENS

    Julka et al. (28)



    TENS long-term use (average: 1.7 years)

    Treatment remains effective even with prolonged use

    Forst et al. (30)

    Randomized, controlled,


    TENS or sham treatment, 12 weeks, at least 30 min daily

    After 6 weeks significant improvements in VAS, sign. improvements in NTSS-6-score after 6 and 12 weeks

    Armstrong et al. (31)

    Pilot study



    Pulsed-dose electrical stimulation by stocking electrodes, 4 weeks active treatment, 8 h/day, nightly

    Therapy may be effective in patients with grossly intact protective sensation and relatively good distal vascular perfusion

    Oyibo et al. (32)



    Pulsed-dose electrical stimulation by stocking electrodes, 6 weeks active treatment, 8 h/day, nightly

    No evidence, poor compliance

    Weintraub & Cole (33)

    Pilot study



    PEMF, 1 h on 9 consecutive days

    Short-term analgesic effect in more than 50% of patients

    Musaev et al. (34)


    PEMF at different frequencies (100 Hz, 10 Hz), 10 days, 10–15 min., + massage and exercise

    Reduction in pain, significant regression of major subjective symptoms and improvements in the conductive functions of peripheral nerves

    Wróbel et al. (35)

    placebo-controlled, double-blinded


    Low-frequency pulsed magnetic field, 15 days, 20 min

    Positive impact on pain, quality of life and sleep, but not better than placebo

    Weintraub et al. (36)

    double-blinded, placebo-controlled


    PEMF, 3 months, 2 h/day

    No significant reduction in pain and sleep disturbance, but neurobiological changes in skin biopsy

    Weintraub et al. (37)

    Multicentre, randomized,
    placebo-controlled, double-blinded


    Static magnetic field, shoe insoles for 4 months (24 h/day)

    Significant reduction in pain pronounced during the third and fourth month

    Reichstein et al. (38)

    Randomized, controlled, prospective pilot study



    High-frequency external muscle stimulation or TENS, 30 min daily for
    3 consecutive days

    Amelioration of symptoms and pain, more effective than TENS

    Klassen et al. (39)

    Prospective, non-randomized pilot study


    High-tone external muscle stimulation,
    1 h, 3×/week, 1–3 months

    Significant improvements of discomfort, pain and sleep disorders

    Humpert et al. (40)

    Prospective, uncontrolled


    External muscle stimulation 4 weeks,
    60 min, 2×/week

    EMS seems to be effective for symptomatic neuropathy, especially in patients with strong symptoms

    Bosi et al. (41)

    double-blinded, placebo-controlled



    Frequency-modulated electromagnetic neural stimulation, 20 treatments,
    30 min/treatment

    Significant reduction in pain, significant increase in sensory tactile perception, increase in motor nerve conduction velocity for at least 4 months

    NTSS-6-score: New Total Symptom Score; VAS: visual analogue scale; TENS: transcutaneous electrical nerve stimulation; EMS: external muscle stimulation. A (high): several high-quality studies with consistent results; B (moderate): one high-quality study, several studies with some limitations; C (low): one or more studies with severe limitations; D (very low): expert opinion, one or more studies with very severe limitations (43).

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Volume 42, Issue 4

DOI: 10.2340/16501977-0554

Pages: 289-295

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