The diabetic peripheral neuropathy could be managed with non-pharmacological interventions like alpha-lipoic acid and spinal cord stimulation; said the scientists of Hopkin Hospital, Baltimore, USA. Some diabetic neuropathy patients may not be adequately relieved with conventional therapies or may face adverse effects. Thus, the scientists focused on evaluating the efficacy and safety of some non-pharmacological treatments by conducting a systematic analytical review.

For randomised controlled trials, the Cochrane Central Register of Controlled Trials, MEDLINE and Embase from the period of 1966 to May 24, 2016, were searched. Two reviewers determined the studies associated risk of bias, eligibility, a graded strength of evidence (SOE) and serially abstracted data for critical outcomes (quality of life and pain).

A total of twenty-three trials were selected which involved various techniques to counter pain. The alpha lipoic acid was found to be more effective over placebo (moderate SOE), and frequency-modulated electromagnetic stimulation was more effective than the sham (low SOE). Electrical stimulation showed no pain-controlled properties. Further, spinal cord stimulation exhibited a more significant reduction in pain as compared to usual care but had severe complications. Other approaches such as acupuncture, cognitive behavioural therapy presented insufficient evidence and physical therapy trials or exercise not even met the inclusion criteria. Many of the trials were short-term and with an unclear risk of bias. No adequate evidence was presented by treatment on quality-of-life. Spinal cord stimulation and alpha-lipoic acid found helpful in reducing pain. However, spinal cord stimulation showed some adverse effects. These events indicate that further investigation is required to evaluate long-term outcomes for these non-pharmacological approaches and to find more suitable non-pharmacological interventions to manage diabetic neuropathy.