title: Comparison of Transcutaneous Electrical Nerve Stimulation and Pulsed Radiofrequency Sympathectomy for Treating Painful Diabetic Neuropathy.
abstract: BACKGROUND
  Painful diabetic peripheral neuropathy (DPN) is a long-term complication of type 1 and type 2 diabetes that majorly impacts quality of life. Its prevalence increases with age and duration of diabetes. It is more common in patients who have suboptimal glycemic control over several years. Because DPN may be resistant to conventional treatments, it is common for patients to only have partial pain relief. Therefore, new therapeutic options are needed for the condition.
  
  
  OBJECTIVE
  The aim of the present study was to compare the efficacy of transcutaneous electrical nerve stimulation (TENS) and pulsed radiofrequency (PRF) lumbar sympathectomy in treating painful DPN.
  
  
  METHODS
  Sixty-five patients with painful DPN refractory to conventional treatment were randomly and evenly assigned to either the TENS or PRF lumbar sympathectomy groups. Pain evaluations were based on the 10-point numerical rating scale (NRS). Subjects were followed for three months and had a total of four study visits (baseline and 1 week, 1 month, and 3 months after treatment).
  
  
  RESULTS
  Sixty patients completed all study visits. In both groups, the NRS rating significantly decreased after treatment, with a marked pain reduction observed at the first follow-up evaluation. In the PRF group, the NRS decreased from 6.46 at baseline to 2.76 at the 1 week visit. One and 3 months after treatment, the NRS was 4.30 and 5.13, respectively (P < 0.0001). In the TENS group, the NRS decreased from 6.10 at baseline to 3.96 at the 1 week visit. One and 3 months after treatment, the NRS was 5.23 and 5.90, respectively (P < 0.0001). Unfortunately, the NRS steady increased almost back to baseline levels in the TENS group. The NRS only slightly increased during the follow-up period in the PRF group, but did not reach baseline levels.
  
  
  CONCLUSIONS
  Both TENS and PRF lumbar sympathectomy are promising pain relief treatments for painful DNP. However, PRF lumbar sympathectomy seems to have a superior efficacy. Further studies with a larger sample size and a longer follow-up period are needed.
authors.affiliation: Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Bahram
authors.initials: B
authors.lastname: Naderi Nabi
authors.affiliation: Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Abbas
authors.initials: A
authors.lastname: Sedighinejad
authors.affiliation: Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Haghighi
authors.affiliation: Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Gelareh
authors.initials: G
authors.lastname: Biazar
authors.affiliation: Department of Anesthesiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Masood
authors.initials: M
authors.lastname: Hashemi
authors.affiliation: Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Soodabeh
authors.initials: S
authors.lastname: Haddadi
authors.affiliation: Department of Anesthesiology, Anesthesiology Research Center, Guilan University of Medical Sciences, Rasht, Iran.
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Fathi
keywords: Painful Diabetic Neuropathy; Pulsed Radiofrequency Treatments; TENS