SILVER THERA STOCKING ELECTRODES
AND PULSED GALVANIC STIMULATION
THERAPY IN THE RELIEF OF PAINFUL DIABETIC NEUROPATHIES AND WOUND HEALING
OF LEG/ FOOT ULCERS IN DIABETIC PERSONS PRACTICE BASED OBSERVATIONAL DIABETIC
MEDICINE
One of the most distressing, depressing and disturbing
complications of diabetes is chronic painful neuropathy.
The pain is variable:
• Mild parasthesia (numbness) in a few toes or the whole foot.
• Shooting, fleeting type of pain in the feet, toes.
• Severe unremitting pain in one or both legs/ feet.
• Character of pain described as
Burning, shooting, lancinating (pins and needles), aching (boring), with
nocturnal flare-up (exacerbation) - all may be combined in the same patient.
• Allodynia: Severe sensory neuropathy symptoms over the affected
areas so that the person is unable to wear even clothes which aggravate
the symptoms.
• Loss of sleep due to symptoms.
• Pain is a subjective experience and varies from person to person
depending upon their threshold for pain as well as previous experience.
It is difficult to quantify(refer to painful Neuropathy).
• Occasionally special tests like EMG/ MCV (Electrophysiological
tests) may be required to rule out other organic underlying causes before
diagnosing diabetic neuropathy.
• In our practice about 15% of Type 2 Diabetes patients complain
of some disability due to Diabetic Neuropathy in the lower limbs.
PRESENTLY AVAILABLE TREATMENT MODALITIES:
Treatment of pain in Diabetic Neuropathy Current
Procedures:
Current Procedures:
1) NSAID (Non- Steroidal Anti- Inflammatory- Drugs)
2) TRICYCLIC Compounds (Anti- Depression Drugs)
3) MIANSERIN A non tricyclic antidepressant found to be effective in the
treatment of neuropathic pain - Young and Clarke, 1985-Recent studies
question this.
4) Selective serotinin reuptake inhibitors - CITALOPRAM and PAROXETINE
5) Anticonvulsants: Carbamazepine, gabapentine
6) I.V. Lignocaine and Oral mexiletine
7) Topical Agents: There are many in India, but the well studied one is
Capsaicin - releases substance P from sensory nerve terminals causing
its depletion after many applications.
8) Opsite dressings(1994) popularized by Ms. Ali Foster of King's College
Hospital, London, U.K.
9) Miscellaneous Compounds: Clonazepam, Clonidine, Pyridoxine, Pentoxifylline,
Calcium pantothenate, Opsite- dressing, etc…
10)Electrical spinal cord stimulation: "GATE THEORY" (Melzack and Wall
1965) Watkins and Koeze, 1993 Tesfaye 1995
11)TRANSCUTANEOUS ELECTRICAL NERVE STIMULATION (TENS) - THORSTEINSSON,
1997 Popularly used both at the clinic and home levels; not very effective
mainly because diabetic neuropathic pain is usually symmetrical and affects
many nerves, and thus is unlikely to respond to single nerve stimulation
- Solomon Tesfaye and David E. Price in 'Diabetic Neuropathy' - 1997
Other approaches for pain relief:
1) Meticulous blood sugar control
2) Vasodilators
3) ACE inhibitors
4) Aldose Reductase Inhibitors
5) Anti Oxidants
6) Inhibitors of AGE (Advanced Glycation End products)
7) Essential Fatty Acids (GLA) (ALA)
8) Magnetic field therapy (limited relief, poor reproducibilits)
9) Evening Primrose Oil ( Capsules)
Silver Thera Stocking
Electrodes with Pulsed Galvanic Stimulation in the treatment of Painful
Diabetic Neuropathies
We started using this in our patients from September,
1999 and till date over 500 patients have been treated. The equipment,
methodology and application is simple, easy to understand and use and
is reproducible by the doctor, nurse or the patients themselves. It is
painless, non- invasive and relatively fool - proof.
1) The accompanying photographs show the use of Silver thera stocking
treatment at our center.
2) Depending on the severity of the cases, 10 to 14 sittings of 1 to 4
hours (intermittent) each of protocol 1 or 8 hours (intermittent) of protocol
2 is given to the part affected.
3) If sufficient good response is achieved, a follow up therapy once or
twice a week for 6 to 12 weeks.
4) Our results have been extremely gratifying with a success rate of around
90% in terms of relief from pain and other parameters.
5) Scientific support of this therapy is given in the following two papers.
• 'Is electrical stimulation effective in reducing Neuropathic
pain in patients with Diabetes?' (David G Armstrong, Lawrence A Lavery,
John G. Fleischli and Karry Ann Gilham The Journal of Foot & Ankle Surgery,
Vol.36, 4, 1997)
• 'The benefit of Electrical stimulation to enhance Perfusion
in persons with Diabetes Mellitus' (Edgar J G Peters, David G Armstrong,
Robert P Wunderlich, Jan Bosme, Susan Stackpoole - Shea, and Lawrence
A Lavery The Journal of Foot & Ankle Surgery, Vol.37,5, Sep/Oct, 1998.)
Silver Thera Treatment:
Apart from Diabetic Neuropathy, it is also useful and gives relief in
1) Healing of Ulcers.
2) Knee pains (Osteo-arthritis).
3) Low back- pain (of non - organic cause).
4) Muscular- skeletal aches and sprains due to sports and other injuries.
5) Carpal - Tunnel syndrome.
6) Cervical and Lumbar Spondylosis with pains.
7) Peri arthritis of the shoulders (Frozen - shoulder).
8) Tennis - Elbow and many other similar problems.
9) Recent experience has shown that pulsed halvanic stimulation using
the silver mesh stocking electrodes afforded and almost 100% relief in
severe intractable painful uraemic neuropathies
