Electroacupuncture Shows Benefits in Diabetic Peripheral Neuropathy

Nancy A. Melville

August 06, 2018

Electroacupuncture is effective and safe in the treatment of painful diabetic peripheral neuropathy (PDN), offering a nonpharmacologic option for the persistent pain, according to results of the first multicenter randomized controlled trial on the issue.

"The results of this study demonstrate that electroacupuncture treatment is effective

for reducing pain and improving sleep disturbance and quality of life in PDN," the authors report.

The study was published recently in Diabetes Care and conducted by Kyung-Min Shin and colleagues from the Clinical Medicine Division, Korea Institute of Oriental Medicine, in Daejeon, South Korea. It involved 126 patients recruited from June 2014 to March 2015 with type 2 diabetes, a 6-month or longer history of PDN, and a mean weekly pain score of 4 or higher on the Pain Intensity Numerical Rating Scale (PI-NRS).

Electroacupuncture Was Well Tolerated and Safe

The patients were randomly assigned to a group receiving twice-weekly treatments of electroacupuncture or a control group for 8 weeks. Both groups also received an educational brochure on diet and lifestyle modification for diabetes.

The acupuncture treatments involved a mixed current of 2 Hz/120 Hz, delivered at 12 acupuncture points and 1 optional additional acupuncture point, established by the World Health Organization.

At the 8-week follow-up assessment, 9 participants in the electroacupuncture group and 19 in the control group had dropped out.

In terms of the primary outcome of pain, measured by the PI-NRS score at the ninth week of follow-up, patients receiving electroacupuncture showed significantly greater improvement compared with the control group (P = .01).

Of those in the treatment group, nine (15.52%) were responders, defined as achieving a reduction of 50% or greater on the PI-NRS, compared with just three (6.25%) in the control group (P = .21).

Those receiving electroacupuncture also had significantly greater improvements in pain, as measured by the short-form McGill Pain Questionnaire; their sleep interference, which is a common problem with PDN, also improved, as did pain scores assessed by EuroQol-5 Dimensions, after 9 weeks (P < .05).

And as many as 82.5% in the electroacupuncture treatment group reported improvements in Patient Global Impressions of Change compared with 34.1% in the control group, and the improvement was maintained through 17 weeks.

The specific acupuncture treatment points in the study included bilateral Zusanli (ST36), Xuanzhong (GB39), Yinlingquan (SP9), Sanyinjiao (SP6), Taichong (LR3), and Zulinqi (GB41); the additional acupuncture point of Bafeng (EX-LE10) was also available as an option.

There were no significant differences between the groups in terms of age, sex, duration of diabetes (12.53 years in the electroacupuncture group and 11.32 years in the control group), pain duration (electroacupuncture group, 3.81 years; control group, 3.23 years), and use of antidiabetes medication.

Patients in both groups were permitted to take rescue medication of acetaminophen 500 mg, with a maximum dosage of 3000 mg per day, but no other analgesic medication was allowed. The consumption of the medications did not differ throughout the study.

The groups also remained on stable doses of their antidiabetes medications.

No safety issues were reported with electroacupuncture, and the two groups had an equal incidence of adverse events (n = 12) and serious adverse events (n = 3 each).

"Electroacupuncture treatment was well tolerated and safe during this study," the authors say.

They noted that the study is the first randomized trial of its kind: "To our knowledge, this is the first multicenter randomized controlled trial to evaluate the effectiveness and safety of electroacupuncture treatment for the management in PDN."

"These findings suggest that  [the] treatment may be recommended as a non-pharmacological treatment for pain reduction in PDN."

Lack of Effective Comparator Remains a Limitation for Acupuncture Research

With electroacupuncture, a small electric current is passed between two acupuncture needles to deliver stimulation. As previously reported by Medscape Medical News, a pilot study showed that traditional acupuncture improved chemotherapy-induced peripheral neuropathy related to breast cancer treatment — a serious problem shown to occur in nearly 50% of women, sometimes for years after treatment.

The authors of that study and the current study, however, each acknowledge the important limitation of a lack of a sufficient placebo or sham group to serve as an active control, and they note that the nature of an effective comparator remains a challenge in acupuncture research.

The study received support from the Korea Institute of Oriental Medicine. The authors have disclosed no relevant financial relationships.

Diabetes Care. Published online July 30, 2018.  Abstract

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