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Improved foot sensitivity and pain reduction in patients with peripheral neuropathy after treatment with monochromatic infrared photo energy—MIRE
Journal of Diabetes and its Complications Volume 20, Issue 2 , March-April 2006, Pages 81-87
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The medical records of 2239 patients (mean age=73 years) with established peripheral neuropathy (PN) were examined to determine whether treatment with MIRE was, in fact, associated with increased foot sensitivity to the Semmes Weinstein monofilament (SWM) 5.07 and a reduction in neuropathic pain. The PN in 1395 of these patients (62%) was due to diabetes. Prior to treatment with MIRE, of the 10 tested sites (5 on each foot), 7.1±2.9 were insensitive to the SWM 5.07, and 2078 patients (93%) exhibited loss of protective sensation defined by Medicare as a loss of sensation at two or more sites on either foot. After treatment, the number of insensate sites on both feet decreased to 2.4±2.6, an improvement of 66%. Of the 2078 (93%) patients initially presenting with loss of protective sensation, 1106 (53%) no longer had loss of protective sensation after treatment (P<.0001); 1563 patients (70%) also exhibited neuropathic pain in addition to sensory impairment. Prior to treatment with MIRE, pain measured on the 11-point visual analogue scale (VAS) was 7.2±2.2 points, despite the use of a variety of pain-relieving therapeutic agents. After treatment with MIRE, pain was reduced by 4.8±2.4 points, a 67% reduction. Therefore, MIRE appears to be associated with significant clinical improvement in foot sensation and, simultaneously, a reduction in neuropathic pain in a large cohort of primarily Medicare aged, community-dwelling patients, initially diagnosed with PN. The quality of life associated with these two outcomes cannot be underappreciated.
The restorative effects of pulsed infrared light therapy on significant loss of peripheral protective sensation in patients with long-term type 1 and type 2 diabetes mellitus. Acta Diabetol. 2006 May;43(1):26-33
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Pulsed infrared light therapy (PILT) has been shown to increase peripheral sensation in diabetic patients with diabetic peripheral neuropathy (DPN). However, most studies last for very short periods, with the subjects receiving only 6-20 treatments. The purpose of this study was to evaluate the effectiveness of an eight-week course of PILT in reversing long-standing, profound DPN in patients with type 1 and type 2 diabetes. Twenty-two subjects with a diagnosis of type 1 (n=2) or type 2 (n=20) diabetes participated in the study. PILT was administered to one foot chosen at random with the other foot serving as a within-subject control (no treatment). Patients underwent 24 treatments (3 times/week, for eight weeks) for 30 min per treatment. Changes in peripheral protective sensation (PPS) were measured using Semmes-Weinstein monofilaments (SWM) ranging from 3.7 to 6.48. PILT improved PPS even in patients with long-standing chronic neuropathies whose initial pre-study sensation was not measurable with a 200-g SWM. PILT significantly improves PPS. While the exact mechanism of action is not understood, infrared light may improve peripheral neuropathies by improving foot perfusion by stimulating nitric oxide production.
Re: Peripheral neuropathy improvment with infrared photo energy
Does Anodyne Light Therapy Improve Peripheral Neuropathy in Diabetes? A Double Blind, Sham Controlled Randomized Trial to Evaluate Monochromatic Infrared Photo Energy.
Lavery LA, Murdoch DP, Williams J, Lavery DC. Diabetes Care. 2007 Oct 31; [Epub ahead of print]
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Objective: To determine the efficacy of Anodyne Monochromatic Infrared Photo Energy (MIRE) in-home treatments over a 90-day period to improve peripheral sensation and self-reported quality of life in persons with diabetes mellitus.
Methods: This was a double blinded randomized, sham controlled clinical trail. We randomized 69 persons with diabetes and vibration perception threshold between 20-45 volts into two treatment groups. Patients were randomly assigned to active or sham treatment groups. Sixty patients (120 limbs) completed the study. Anodyne units were used at home every day for 40 minutes for 90 days. We evaluated nerve conduction velocities, vibration perception threshold, Semmes Weinstein Monofilaments (SWM) (4, 10, 26, and 60 gram monofilaments), the Michigan Neuropathy Screening Instrument (MNSI), 10 cm visual analog pain scale, and the Neuropathy Quality of Life Instrument. We used a nested repeated measures MANOVA design. Two sites (great toe and fifth metatarsal) were tested on both the left and right feet of each patient, so, two feet were nested within each patient, and two sites were nested within each foot. To analyze the ordinal SWM scores, we used a nonparametric factorial analysis for longitudinal data.
Results: There were no significant differences in measures for quality of life, Michigan Neuropathy Screening Instrument, VPT, SWM, or NCV's in active or sham treatment groups (p>0.05).
Summary: Anodyne MIRE therapy was no more effective than sham therapy in the treatment of sensory neuropathy in persons with diabetes.
Four patients with diabetic foot ulcers that failed to heal after one month of treatment underwent anodyne therapy. Each therapy session lasted half an hour and was conducted 3 times a week for patients at home or daily for patients in hospital, for one to 2 months. The wound sizes and depths were graded according to the Wagner classification. Pictures were taken to evaluate the effects of anodyne therapy. All 4 patients had good healing of their foot ulcers. Anodyne therapy augments the effects of conservative treatment. Proper wound care and appropriate antibiotic coverage remain the basis of treatment.
Re: Peripheral neuropathy and infrared photo energy
The effect of monochromatic infrared energy on transcutaneous oxygen measurements and protective sensation: results of a controlled, double-blind, randomized clinical study.
Franzen-Korzendorfer H, Blackinton M, Rone-Adams S, McCulloch J. Ostomy Wound Manage. 2008 Jun;54(6):16-31
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Monochromatic infrared energy has been reported to restore protective sensation by increasing circulation. A controlled, double-blind, quasi-experimental, randomized clinical study was conducted to 1) examine the effects of monochromatic infrared energy treatments on tissue perfusion, 2) determine the effects of a published monochromatic infrared energy neuropathy protocol on sensation on the feet of patients with diabetes and a loss of protective sensation; 3) examine monochromatic infrared energy's effect on pain; and 4) examine the relationship between transcutaneous oxygen levels and loss of protective sensation. The study was conducted at a wound and hyperbaric treatment center in Norwalk, Conn; 18 adults (12 men, six women; mean age 65 +/-13 years, range 39 to 86 years) with diabetes and loss of protective sensation were recruited using convenience sampling methods. All patients served as their own control. Pre- and post treatment tests assessed sensation, pain, and transcutaneous oxygen measurements on two sites per foot. Participants underwent a series of 30-minute monochromatic infrared energy treatments (one foot active treatment, one foot sham). Monochromatic infrared energy was delivered at the manufacturer pre-set level of energy of 1.5 J/cm2/min at a wavelength of 890 nm; sham units delivered no energy. Scores were analyzed using paired t-tests and Pearson's correlation coefficient. No significant differences were observed between active and sham treatments for transcutaneous oxygen values, pain, or sensation. Both active and sham monochromatic infrared energy-treated feet had significantly improved sensation when compared to pretest baseline scores (P <0.05). No statistical relationship was found between transcutaneous oxygen and sensation. This small study did not demonstrate any effects of monochromatic infrared energy treatment on transcutaneous oxygen measurements, pain, or sensation in adults with diabetes and loss of protective sensation.
Re: Peripheral neuropathy and infrared photo energy
Pulsed infrared light therapy does not increase nitric oxide concentration in the blood of patients with type 1 and type 2 diabetes mellitus.
Arnall DA, Nelson AG, Stambaugh L, Sanz Sevilla N, Cebrià I Iranzo MA, López Bueno L, Sanz I, Arnall SB. Acta Diabetol. 2008 Dec 24. [Epub ahead of print]
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The purpose of this study was to determine if NO blood concentrations increased acutely following an 8-week course of pulsed infrared light therapy (PILT) which could be linked to an improvement in peripheral protective sensation (PPS) in patients who have profound chronic diabetic peripheral neuropathy. A total of 22 subjects with the diagnosis of type 1 (N = 2) or type 2 (N = 20) diabetes participated in the study. PILT was administered to one foot chosen at random with the other foot serving as a within-subject control (no treatment). Patients underwent 24 treatments (3 times/week, for 8 weeks) for 30 min per treatment. Venous blood samples were taken during the last 5 min of treatment from veins in the dorsum of the control and experimental feet and were later analyzed for NO concentration. Contrary to the popular supposition, PILT treatments actually resulted in a significantly (P < 0.05) decreased concentration of NO. Additionally, there were no significant differences between the treated and untreated feet. Since in individuals where PILT has significantly improved PPS, PILT did not stimulate an increased NO content in the blood, it appears that infrared light improves peripheral protective sensation in patients by a mechanism other than an increased NO production
Peripheral neuropathy and infrared photo energy
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