Electrotherapy for Diabetic Neuropathy & Foot Pain
Diabetic neuropathy, a common complication of diabetes, often leads to significant foot pain, impacting patients' mobility, quality of life and, particularly troubling, it’s a leading cause of amputation. Effective pain management strategies are essential to alleviate discomfort and enhance daily functioning.
Providers unfamiliar with prescription-strength electrotherapy devices, such as the RS-4i® Plus, may be interested to learn how Interferential Therapy (INF) and Neuromuscular Electrical Stimulation (NMES) can help patients suffering from diabetic neuropathy, as well as other painful foot and lower leg conditions.
Before we begin, let’s provide some definitions:
What is electrotherapy: Electrotherapy involves using electrical energy to stimulate nerves and muscles. It can help reduce pain, improve circulation, and promote tissue healing, making it a valuable tool in treating conditions like diabetic neuropathy.
Transcutaneous Devices (TENS): Transcutaneous devices transmit electrical signals through the skin by way of electrode pads that adhere on top of the treatment area. The challenge – the confusion, really – is that the category itself and a specific device type within the category both get referred to as TENS. It’s a bit like facial tissue being called Kleenex®. There is a specific brand named Kleenex within the facial tissue category, but many people have gotten used to calling all facial tissues “Kleenex.” Later in the article we will explain how the RS-4i Plus is nothing like the over-the-counter TENS device you may be familiar with.
What is Interferential Therapy (INF)? Interferential therapy uses two slightly different high-frequency signals (>5000 Hz) that intersect within the body to create an area of interference – a “sweet spot” in the treatment area where the therapeutic benefit is most pronounced. The nature of high-frequency assures that these signals are able to overcome the skin’s natural resistance and reach nerves deep in the tissue, providing fast-acting pain relief via the Gate Control Theory of Pain. As an added advantage, they also offer long-lasting pain relief via the release of endogenous opiates.
What is Neuromuscular Electrical Stimulation (NMES)? Neuromuscular Electrical Stimulation (NMES) uses alternating low-frequency signals (<100 Hz) to treat muscle tissue. These low-frequency signals cause skeletal muscle to contract and release in a pattern that acts as a blood and lymphatic fluid pump – i.e., the blood pump mechanism of action. The key benefits of this contract-and-release pattern are that it prevents disuse atrophy, increases circulation and re-educates tissue.
Step One: Pain Relief with Interferential Therapy (INF)
Patients with Diabetic Neuropathy are in pain. Addressing this pain first is key to successful treatment and patient adoption. This is why the RS-4i Plus treatments begin with a couple minutes of Interferential Therapy (INF), which blocks the transmission of pain signals to the brain with a high-frequency waveform that penetrates deep into tissue.
Step Two: Muscle Rehabilitation with Neuromuscular Electrical Stimulation (NMES)
After the Interferential Therapy has run, the RS-4i Plus delivers Neuromuscular Electrical Stimulation (NMES) to facilitate muscle rehabilitation. For diabetic neuropathy patients, NMES can be used on muscles of the lower leg to stimulate blood flow – causing muscles like the gastrocnemius muscle to fire, supplying a flow of oxygen – and nutrient-rich blood to the foot, while expelling metabolic waste.
Step Three: Intersperse Combines both INF and NMES
As the patient sits undisturbed, the third and most unique segment begins. It consists of RS Medical’s patented Intersperse® technology, which combines INF pain relief and NMES rehabilitative muscle stimulation in a single treatment. With Intersperse, during the “relax” period of muscle stimulation, pain relief signals are delivered. The treatment is knocking down the pain, then working the muscle in a repeating pattern. This leads to shorter treatment times and avoids the need for patients to move electrodes or switch devices, which is required by other devices on the market.
This high-powered combination of reduced pain and improved blood flow can help these patients begin to break the cycle of debilitation, which is a desired outcome for everyone.
Electrode Placement for Diabetic Neuropathy & Foot Pain
View pad placement for Diabetic Neuropathy and foot pain. If you have specific questions on placement, please contact our team or request a demonstration using the form below.
The RS-4i Plus versus an over-the-counter TENS unit
The RS-4i Plus is a prescription-strength electrotherapy treatment that, while often categorized as a TENS unit, has little in common with over-the-counter TENS devices.
Higher Frequency Leads to Deeper Penetration:
Many over-the-counter TENS devices have a frequency of 50 Hz. This low-frequency signal means that the device has to be worn on a continual basis. Once it’s removed, the pain relief also stops. In comparison, the RS-4i Plus has a frequency of 5,000 Hz. This high-frequency allows the RS-4i Plus to penetrate deeper into tissue and only needs to be used for 30 minutes once or twice per day to provide relief that lasts for a period of several hours.
While it sounds incredible, science shows that this longer-lasting pain relief from the RS-4i Plus is likely achieved through the release of endogenous opioids, the body’s natural painkillers. Higher-frequency signals stimulate the brain in a particular way, causing it to emit these neuropeptides that inhibit the communication of pain signals. Patient feedback indicates that endogenous opioid-based pain relief may last anywhere from 4-8 hours post-treatment.
Premodulation Leads to a Larger Treatment Area:
Some electrotherapy devices on the market, such as a TENS device, provide Interferential therapy (INF) by crossing electrodes on the patient’s body to intersect different frequency signals. Where the signals cross in the treatment area is where the therapeutic benefit is most pronounced. (Image A)
The signals from the RS-4i Plus are premodulated, meaning that the current for each channel is pre-mixed within the device, as opposed to inside the body. Because signals are pre-mixed, the area of interference stretches between each set of electrodes, not just where signals intersect. The result is that premodulated INF provides a significantly broader area of pain relief. (Image B)
To get a more in-depth comparison, take a look at these articles:
Benefits for Additional Foot & Ankle Conditions
While helping alleviate the effects of diabetic neuropathy is key, this isn’t the only foot-related condition that can benefit from the RS-4i Plus. It’s also useful for treating the pain caused by plantar fasciitis, rheumatoid arthritis, gout and other afflictions of the foot and lower leg.
Additionally, any of these conditions can benefit from the increased blood flow provided by NMES to help prevent muscle spasms, curb atrophy and improve ambulatory ability. And with patients self-reporting four or more hours of pain relief after a 35-minute treatment, it’s a therapeutic option worth considering.
Designed for At-Home Pain Management
The RS-4i Plus is designed for at-home use, and all aspects of patient training can be managed remotely. Once the unit has been prescribed, it is shipped to the patient at home. The patient then receives a personalized virtual fitting and training on the device with an RS Medical representative, which enables them to follow the prescribed treatment plan independently. Because it’s self-administered and simple to use, it goes a long way toward improved patient compliance.
By having treatments that patients can self-manage – whether that’s during the day or the middle of the night – they can get the necessary treatment in their actual moments of need.
Take the Next Step
Healthcare providers who are interested in discovering how the RS-4i Plus may work for your Diabetic Neuropathy and foot pain patients, we invite you to complete the form below. A team member will be in touch to schedule a virtual product demonstration.
The RS-4i Plus requires a prescription. Patients who are interested in discussing this high-powered, non-opioid treatment option with their healthcare provider can download our patient discussion guide here.
Related Resources
Blog: Non-Drug Therapies May Improve Outcomes for Soldiers with Chronic Pain
Blog: How to Compare TENS Units by Price
This blog provides general information and discussion about medicine, health and related subjects. The words and other content provided in this blog, and in any linked materials, are not intended and should not be construed as medical advice. If the reader or any other person has a medical concern, he or she should consult with an appropriately-licensed physician or other healthcare professional.