# Complementary Therapies of Diabetic Peripheral Neuropathy and Intermittent Claudication

## TL;DR

A patient with severe diabetic peripheral neuropathy and peripheral artery disease showed significant symptom improvement using a combination of alternative therapies when standard treatments failed.

## Contribution

The paper presents a novel case study exploring off-label complementary therapies for treatment-resistant diabetic peripheral neuropathy.

## Key findings

- The combination of therapies increased the patient's claudication distance from 16 m to 300–400 m.
- Subjective pain and sleep improved despite inconsistent objective vascular and neurological changes.
- The results suggest alternative therapies may offer symptomatic relief for patients with limited treatment options.

## Abstract

Epidemiological studies have shown that the prevalence of diabetic peripheral neuropathy (DPN) will increase. Currently, DPN is treated medically. In many instances, the outcome is less than satisfactory, and the treatment is associated with side effects. We report a case of severe DPN and peripheral artery disease that are refractory to medical treatment. The patient was treated by external counterpulsation (ECP), electrical neuromuscular stimulation, a footbath in CO2-enriched water, and hydrogen inhalation, all of which are considered off-label. The patients also took L α-lipoic acid and vitamin B12 and were advised on lifestyle modification. The combination of treatments significantly improved the patient’s pain and claudication distance, increasing it from 16 m to 300–400 m. Additionally, as a result of the decrease in nocturnal pain, the patient experienced restful sleep. The reasons for the improvement in subjective symptoms are unclear, as changes in objective vascular and neurological measurements were inconsistent with the subjective improvement. This dissociation highlights the need for further research. Given the symptomatic relief observed, however, such alternative therapies could be considered on a case-by-case basis for patients with DPN who have limited treatment options.