ROLE OF ANODYNE THERAPY

MONOCHROMATIC INFRARED PHOTOENERGY IN DIABETIC PERIPHERAL NEUROPATHY

DR GHANSHYAM GOYAL, DR A K JAIN, DR REKHA SRIVASTAVA

S.K.DIABETES RESEARCH AND EDUCATION CENTRE118, R.R.Sarani, Kolkata -9

skdiab@yahoo.co.in

Distal polyneuropathy is the most common complication affecting the lower extremities of patients with dm

Upto 60% of patients with long standing dm, had dpn

Neuropathy, a major etiological component of diabetic foot ulcer

Is present in more than 82% of diabetics with foot wounds

Is a leading cause of amputations and high mortality rates among diabetics.

SYMPTOMS Burning

Tingling

Stabbing & pins & needles sensation in a stocking & gloves distribution

Patient may often display muscle weakness, incoordination and ataxia

The association between neuropathic pain and

decreased quality of life in patients with DPN is well

documented.

PATHOGENISIS OF DPN Poorly understood

Multifactorial

Hyperglycemia - being the prime risk factor

Ischaemic

THEORIES Abnormalities of protien glycation Sorbitol accumalation Polyol pathway flux Protein kinase activation Advanced glycation end product Decrease in neuronal nitric oxide

synthaetase protein Microvascular hypoxia

One of the causative factors is

decreased endoneural blood flow

MANAGEMENT OF DN Disease modification Symptomatic treatment DISEASE MODIFICATION Glycaemic control Association of vascular risk factors with DN Aldolase reductase inhibitors(ARIS) Alpha Lipoic acid Carnitine Neurotrophic therapy

SYMPTOMATIC TREATMENT Tricyclic Antidepressants Anticonvulsants ( Phenytoin,

Carbomazepine & Gabapentin) Tramadol Analgesics are not of much benefit

and narcotic should be avoided because of addiction potential.

TNS ANODYNE THERAPY

MIRE TECHNOLOGY

The anodyne therapy system delivers mire through therapy arrays, each containing 60 super-luminous

diodes ( 890 nanometers, near infrared wavelength). These diodes are attached to a control unit that

pulses the mire at 292 times/sec. The therapy arrays are placed in direct contact with the skin to temporarily increase local micro-circulation.

ANODYNE THERAPY

BASELINE CHARACTERISTIC OF PATIENTS

No of patients in study = 47

Mean age = 57.91 ( 38-81 yrs)

Mean duration of diabetes = 12.7 yrs

Mean biothesiometer Right - 35.6 v Left - 35.8 v

Male : female 33: 14

VPT – PRE ANODYNE THERAPY Right Foot Left Foot PRE PRE GT36.48 36.6 1ST MT 34.78 36.70 3RD MT 36.30 35.72 5TH MT 35.80 35.48 INSTEP 33.50 35.10 HEEL 35.80 34.38

VPT – RIGHT FOOT RIGHT FOOT

PRE POST P VALUEGT 36.48 23.50 1ST MT 34.78 22.763RD MT 36.30 22.905TH MT 35.80 21.80 INSTEP 33.50 22.40HEEL 35.80 23.59

Significant

VPT – LEFT FOOT LEFT FOOT PRE POST P

VALUEGT 36.6 21.8 1ST MT 36.70 23.87 3RD MT 35.72 24.4 5TH MT 35.48 24.0 INSTEP 35.10 22.0 HEEL 34.38 23.8

Significant

PATIENT SYMPTOMS SCORE

N = 47 Marked improvemen

t

Improvement

Mild improvemen

tPain 26 07 14

Sensation 14 23 08

Numbness, tingling & parasthesias

21 20 06

Balance 04 18 04

Fall 02 - -

CONCLUSION Our knowledge regarding the

pathogenisis of DN has grown significantly in last two decades

But identifying effective treatment regime remains a challenge

Prevention remains the foundation of clinical intervention and the pre requisites of adequate treatment

Mire treatments are associated with increased foot sensation in patients with dpn

IMPROVED FOOT SENSITIVITY BASED ON THE USE OF MIRE MIGHT BE ASSOCIATED WITH A REDUCED INCIDENCE OF DIABETIC FOOT WOUNDS AND AMPUTATIONS

EVIDENCE CONCERNING THE USE OF MIRE EVIDENCE CONCERNING THE USE OF MIRE FOR DPNFOR DPN

JOURNAL REF n Study Type JOURNAL REF n Study Type EndpointsEndpointsJ J AmerAmer Pod Med Assn (13) 49 Pod Med Assn (13) 49 Prospective,,openProspective,,open label label QuantitativemonofilamentsQuantitativemonofilaments

Hot/Cold DiscriminationHot/Cold Discrimination-------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------Endocrine Practice (12) 27 Endocrine Practice (12) 27 Prospective,,openProspective,,open label Pretreatment control grouplabel Pretreatment control group

Neurometer,CPT/sNCTNeurometer,CPT/sNCT-------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------------Diabetes Care (11) 27 Diabetes Care (11) 27 Randomized,doubleRandomized,double SWM; VAS Pain; MNSI;SWM; VAS Pain; MNSI;

blind,placeboblind,placebo controlledcontrolled BalanceBalance-------------------------------------------------------------------------------------------------------------------------------- ------------------------------------------------------------------------------------------------------J of Geriatric physical (14) 38 J of Geriatric physical (14) 38 Prospective,,openProspective,,open label SWM; label SWM; TinettiTinetti Gait and Gait and TherapyTherapy Balance; Actual FallsBalance; Actual Falls-------------------------------------------------------------------------------------------------------------------------------- ----------------------------------------------------------------------------------------------------Advances in Skin and (15) 8 Advances in Skin and (15) 8 Retropective,questionnaireRetropective,questionnaire Incidence of new woundsIncidence of new woundsWound care Wound care time of healingtime of healingJ J AmerAmer Pod Med Assn (15) 1047 Prospective, chart review SWMPod Med Assn (15) 1047 Prospective, chart review SWM