The pain associated with diabetic neuropathy is characterised by burning, tingling, with pricking sensations with irregular sensory changes. This systematic review described that non-pharmacological therapies like spinal cord stimulation and the use of alpha-lipoic acid found to be more effective than a placebo and can be considered as treatment approach to manage neuropathic pain.

The study aimed to evaluate the advantages and disadvantages of non-pharmacologic treatments for diabetic peripheral neuropathy (DPN) symptoms. A detailed systematic review of available data was conducted.

The randomised controlled trials were selected from the Cochrane Central Register of Controlled Trials, MEDLINE, and Embase from 1966 to May 24, 2016. Two reviewers estimated studies for serially abstracted data, checked the eligibility, assessed the risk of bias and graded strength of evidence (SOE) for critical outcomes. 

A total of twenty-three trials were introduced. It was found that the alpha-lipoic acid was more efficacious than placebo, and frequency-modulated electromagnetic stimulation was more efficient than sham for short-term. No effectiveness was noticed with regards to electrical stimulation for reducing pain. Greater efficiency was exhibited by spinal cord stimulation for pain reduction than usual care but with serious complications. The evidence for acupuncture and cognitive behavioural therapy was inadequate.

On the other hand, physical or exercise therapy did not meet the inclusion criteria. No treatments described adequate evidence on quality-of-life. Most of the studies were short-term and with the unclear risk of bias.

Spinal cord stimulation and alpha-lipoic acid were efficacious for pain; however, studies were short-term and present with quality deficits. Serious adverse events were found in spinal cord stimulation. Additional investigation is required to address long-term results and other non-pharmacologic therapies.