Physiotherapy in Diabetic Peripheral Neuropathy: How Effective Is It?

Diabetic peripheral neuropathy (DPN) is one of the most common and severe complications of diabetes mellitus. It manifests as chronic pain, burning sensations, numbness, reduced sensitivity, and impaired limb function, significantly diminishing patients’ quality of life. In the search for non-pharmacological treatment options, increasing attention has been given to physiotherapy, particularly transcutaneous electrical nerve stimulation (TENS) and therapeutic exercise.

This article examines how effective these approaches are, based on data from randomised clinical trials and meta-analyses.

TENS in Diabetic Neuropathy: Effects on Pain and Symptoms

What Was Studied

A meta-analysis included three randomised controlled trials involving a total of 78 patients with symptomatic DPN. The effectiveness of TENS was compared with placebo stimulation and standard treatment. The primary outcome was pain intensity.

Main Results

• After 4 weeks of treatment, TENS demonstrated a marked reduction in pain compared with placebo(SMD −5.37; 95% CI −6.97 to −3.77).

• After 6 weeks, the effect persisted but was less pronounced(SMD −1.01; 95% CI −2.01 to −0.01).

• After 12 weeks, no statistically significant reduction in pain was observed.

• However, at 12 weeks, patients receiving TENS reported a subjective improvement in overall neuropathic symptoms(WMD −0.18; 95% CI −0.32 to −0.051).

• No adverse effects were reported, and the method was considered safe.
  

Conclusion on TENS

TENS is an effective and safe method for short-term pain reduction in diabetic neuropathy. However, its effect diminishes over time, indicating the need for repeated courses or a combined therapeutic approach. The authors emphasise the necessity of large multicentre studies to assess long-term efficacy.

Therapeutic Exercise in Diabetic Neuropathy

What Was Studied

A systematic review and meta-analysis included 11 randomised clinical trials with 517 patients, comparing therapeutic exercise with no intervention or standard care.

Main Results

Therapeutic exercise showed benefits across several clinical outcomes:

• Reduction in the severity of neuropathic symptoms(MD −1.05; 95% CI −1.90 to −0.20).

• Improvement in objective neurological signs(SMD −0.66; 95% CI −1.00 to −0.32).

• Improvement in physical function (walking, balance, strength)(SMD −0.45; 95% CI −0.66 to −0.24).

• Psychosocial outcomes (mood, quality of life) did not show statistically significant changes.

According to the GRADE system, the overall quality of evidence was rated as very low, due to heterogeneity of exercise protocols, small sample sizes, and short follow-up periods.

Conclusion on Exercise Therapy

Therapeutic exercise may provide short-term benefits for symptoms, neurological signs, and physical function in diabetic neuropathy. However, current evidence does not allow for strong conclusions regarding long-term effects or psychosocial outcomes.

Overall Conclusion

📌 Physiotherapy in diabetic peripheral neuropathy is effective, but with limitations.

• TENS effectively reduces pain and improves subjective symptoms in the short term, with a strong safety profile.

• Therapeutic exercise improves physical function and reduces symptom severity but requires individual tailoring and regular practice.
  

Discuss a comprehensive support program for diabetic peripheral neuropathy Physiotherapy methods such as TENS and therapeutic exercise may form part of an integrated medical strategy aimed at symptom control and functional preservation. An individual medical consultation allows evaluation of whether a comprehensive approach may be appropriate in your specific case. Request a medical consultation