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1362571372 anodyne paper

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anodyne paper

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1362571372 anodyne paper

  1. 1. ROLE OF ANODYNE THERAPY MONOCHROMATIC INFRARED PHOTOENERGY IN DIABETIC PERIPHERAL NEUROPATHY DR GHANSHYAM GOYAL, DR A K JAIN, DR REKHA SRIVASTAVA S.K.DIABETES RESEARCH AND EDUCATION CENTRE 118, R.R.Sarani, Kolkata -9 skdiab@yahoo.co.in
  2. 2.  Distal polyneuropathy is the most common complication affecting the lower extremities of patients with dm  Upto 60% of patients with long standing dm, had dpn  Neuropathy, a major etiological component of diabetic foot ulcer  Is present in more than 82% of diabetics with foot wounds  Is a leading cause of amputations and high mortality rates among diabetics.
  3. 3. SYMPTOMS  Burning  Tingling  Stabbing & pins & needles sensation in a stocking & gloves distribution  Patient may often display muscle weakness, incoordination and ataxia
  4. 4. The association between neuropathic pain and decreased quality of life in patients with DPN is well documented.
  5. 5. PATHOGENISIS OF DPN  Poorly understood  Multifactorial  Hyperglycemia - being the prime risk factor  Ischaemic
  6. 6. THEORIES  Abnormalities of protien glycation  Sorbitol accumalation  Polyol pathway flux  Protein kinase activation  Advanced glycation end product  Decrease in neuronal nitric oxide synthaetase protein  Microvascular hypoxia
  7. 7. One of the causative factors is decreased endoneural blood flow
  8. 8. MANAGEMENT OF DN  Disease modification  Symptomatic treatment  DISEASE MODIFICATION  Glycaemic control  Association of vascular risk factors with DN  Aldolase reductase inhibitors(ARIS)  Alpha Lipoic acid  Carnitine  Neurotrophic therapy
  9. 9. SYMPTOMATIC TREATMENT  Tricyclic Antidepressants  Anticonvulsants ( Phenytoin, Carbomazepine & Gabapentin)  Tramadol  Analgesics are not of much benefit and narcotic should be avoided because of addiction potential.  TNS  ANODYNE THERAPY
  10. 10. MIRE TECHNOLOGY The anodyne therapy system delivers mire through therapy arrays, each containing 60 super-luminous diodes ( 890 nanometers, near infrared wavelength). These diodes are attached to a control unit that pulses the mire at 292 times/sec. The therapy arrays are placed in direct contact with the skin to temporarily increase local micro- circulation.
  11. 11. ANODYNE THERAPY
  12. 12. BASELINE CHARACTERISTIC OF PATIENTS  No of patients in study = 47  Mean age = 57.91 ( 38-81 yrs)  Mean duration of diabetes = 12.7 yrs  Mean biothesiometer Right - 35.6 v Left - 35.8 v  Male : female 33: 14
  13. 13. VPT – PRE ANODYNE THERAPY Right Foot Left Foot PRE PRE GT 36.48 36.6 1ST MT 34.78 36.70 3RD MT 36.30 35.72 5TH MT 35.80 35.48 INSTEP 33.50 35.10 HEEL 35.80 34.38
  14. 14. VPT – RIGHT FOOT RIGHT FOOT PRE POST P VALUE GT 36.48 23.50 1ST MT 34.78 22.76 3RD MT 36.30 22.90 5TH MT 35.80 21.80 INSTEP 33.50 22.40 HEEL 35.80 23.59 Significant
  15. 15. VPT – LEFT FOOT LEFT FOOT PRE POST P VALUE GT 36.6 21.8 1ST MT 36.70 23.87 3RD MT 35.72 24.4 5TH MT 35.48 24.0 INSTEP 35.10 22.0 HEEL 34.38 23.8 Significant
  16. 16. PATIENT SYMPTOMS SCORE N = 47 Marked improvement Improvement Mild improvement Pain 26 07 14 Sensation 14 23 08 Numbness, tingling & parasthesias 21 20 06 Balance 04 18 04 Fall 02 - -
  17. 17. CONCLUSION  Our knowledge regarding the pathogenisis of DN has grown significantly in last two decades  But identifying effective treatment regime remains a challenge
  18. 18.  Prevention remains the foundation of clinical intervention and the pre requisites of adequate treatment  Mire treatments are associated with increased foot sensation in patients with dpn
  19. 19. IMPROVED FOOT SENSITIVITY BASED ON THE USE OF MIRE MIGHT BE ASSOCIATED WITH A REDUCED INCIDENCE OF DIABETIC FOOT WOUNDS AND AMPUTATIONS
  20. 20. EVIDENCE CONCERNING THE USE OF MIREEVIDENCE CONCERNING THE USE OF MIRE FOR DPNFOR DPN JOURNAL REF n Study TypeJOURNAL REF n Study Type EndpointsEndpoints JJ AmerAmer Pod Med Assn (13) 49Pod Med Assn (13) 49 Prospective,,openProspective,,open labellabel QuantitativemonofilamentsQuantitativemonofilaments Hot/Cold DiscriminationHot/Cold Discrimination ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Endocrine Practice (12) 27Endocrine Practice (12) 27 Prospective,,openProspective,,open label Pretreatment control grouplabel Pretreatment control group Neurometer,CPT/sNCTNeurometer,CPT/sNCT ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Diabetes Care (11) 27Diabetes Care (11) 27 Randomized,doubleRandomized,double SWM; VAS Pain; MNSI;SWM; VAS Pain; MNSI; blind,placeboblind,placebo controlledcontrolled BalanceBalance -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- J of Geriatric physical (14) 38J of Geriatric physical (14) 38 Prospective,,openProspective,,open label SWM;label SWM; TinettiTinetti Gait andGait and TherapyTherapy Balance; Actual FallsBalance; Actual Falls ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Advances in Skin and (15) 8Advances in Skin and (15) 8 Retropective,questionnaireRetropective,questionnaire Incidence of new woundsIncidence of new wounds Wound careWound care time of healingtime of healing JJ AmerAmer Pod Med Assn (15) 1047 Prospective, chart review SWMPod Med Assn (15) 1047 Prospective, chart review SWM

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