A study of 15 trials investigating TENS in diabetic neuropathy control found that the treatment relieves painful symptoms after daily application. Another study found superior results with combining TENS and TCA drug therapy. However, the lack of studies involving larger patient populations precludes a conclusive recommendation.

Other types of muscle and nerve stimulation techniques may potentially play a role in neuropathy treatment, but also lack a consensus finding.

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Care of the extremities

Since peripheral neuropathy is one of the most common forms of diabetic neuropathy and pain, caring for the extremities – especially the feet and toes – can provide symptom relief and prevent further damage. A lack of sensation in the feet may lead to unnoticed injuries, wounds or ulcerations that can become infected due to poor circulation.

To avoid these problems, including risk for toe, foot or lower leg amputation, clinicians should conduct annual foot examinations to assess foot pulses and determine ankle reflexes, as well as vibration and pinprick sensations.

Also, be sure to educate patients, so they can perform self-examination and adhere to good hygiene protocols for the feet. Feet should be carefully dried after exercise or bathing to prevent skin breakdown.

For those patients who are unable to bend over or otherwise see the bottoms of their feet, clinicians can suggest the use of wall-mounted mirror or handheld mirror. If a patient’s vision is poor, recommend that a close relative or other loved one perform the inspection. Specifically instruct the examiner to look for cuts, scratches, cracks or other areas of the foot that do not appear normal. If any of these symptoms are noticed, the patient or loved one should seek a health professional’s opinion immediately to avoid complications.

More than 60% of lower-limb amputations that are not caused by trauma occur in people with diabetes. Breaks in the skin that are left unchecked can lead to infection caused by poor circulation and possibly the risk of toe, foot, or leg amputation. Recommending a podiatrist for toenail care can also be beneficial.

Alice McCarthy is a freelance medical writer.


1. UK Prospective Diabetes Study Group. Lancet. 1998;352:854-865.

2. ADVANCE Collaborative Group. Lancet. 2007;370:829-40.

3. The Diabetes Control and Complications Trial Research Group. N Engl J Med. 1993; 329:977-986.

4. Goldstein DJ. Pain. 2005;116:109–118.

5. Rowbotham M. Pain. 2004;110:697–706.

6. McQuay H. Pain. 1996;68:217–27.

7. Shah TH. Am J Hosp Palliat Care. 2010;27: 333–336.

8. Dworkin RH. Nature Reviews Drug Discovery. 2005;4:455–56.

9. Norrie P. Int J Evid Based Healthc. 2010;8:147-8.

10. Zeigler D. Diabetes Care. 2006; 29:2365-2370.