Clinical study on the application of acupoint injection therapy with vitamin B1 in patients with diabetic peripheral neuropathy

Context: Acupoint injection therapy with Vitamin B₁is very effective in the management of diabetic peripheral neuropathy (DPN), and there are few adverse side effects. Aims: The overall purposes of our study are to determine the specific methods of acupoint injection therapy with Vitamin B₁for patients with DPN and to demonstrate the effectiveness of this therapy for DPN patients. Settings and Design: The enrolled patients were divided into two groups – the experimental group (75 patients) and the control group (51 patients). Subjects and Methods: We used four main acupoints in our study – EX-B3, ST36, GB39, and GB34. We compared the changes of DPN symptoms, days of pain loss, changes of tendon reflexes, and electromyographic (EMG) parameters between two groups after 15 days of treatment. Statistical Analysis Used: T-test was used to compare the characteristics between different treatments. Results: The best acupoint set for performing the acupoint injection therapy with 5% Vitamin B₁, includes EX-B3, ST36, GB34, and GB39. The mean efficiency rate in terms of changes of DPN symptoms was 84.5% that is significantly lower compared with 61.9% of control group. Furthermore, the day of the pain loss of experimental group was significant lower than that of control group and the efficiency rates in terms of patellar reflex and Achilles tendon reflex were 90.0% and 89.1%, respectively (P < 0.05). In the experimental group, EMG parameters were improved significantly. Conclusions: Our study suggests that the acupoint injection therapy with Vitamin B₁is preferable, easier, and cost-effective approach in terms of DPN treatment.

Keywords

Acupoints - diabetic peripheral neuropathy - Vitamin B1

Introduction

In case of diabetic peripheral neuropathy (DPN), the management of pain is essential to help prevent further neurological damage and progression.[[1]],[[2]],[[3]],[[4]],[[5]],[[6]]

Many guidelines recommend the use of some drugs, but they are often expensive and result in a number of adverse effects.[[7]],[[8]],[[9]],[[10]],[[11]],[[12]]

The acupoint injection therapy with Vitamin B1 is the preferred treatment option for patients with DPN these days, but its specific methods and effects on DPN have not been sufficiently investigated.[[13]]

Therefore, the purposes of our study are to determine the specific methods of this therapy and to demonstrate the effectiveness for DPN patients.

Subjects and Methods

Individuals with DPN (n = 126, 84 males, mean age: 54.3 ± 4.1) were recruited at the Hospital of the Pyongyang Medical College, Kim II Sung University. This study was approved by the local ethical committee of our hospital. DPN was determined as previously.

The therapeutic modality of the acupoint injection therapy with Vitamin B1 contains two sides – acupoint stimulation using a needle of 5-g syringe[[14]],[[15]] and administration of Vitamin B1 on the corresponding acupoint.[[13]],[[16]]

We used four main acupoints in our study: EX-B3, ST36, GB39, and GB34.[[14]],[[15]] To determine the exact acupoints for injection with Vitamin B1, 45 patients with DPN were divided into three groups according to acupoint prescriptions. In this case, days of pain loss (DPL) were evaluated every 5 days in three groups.

To demonstrate the effectiveness of acupoint injection therapy with Vitamin B1, the enrolled patients were divided into two groups – the experimental group (75 patients treated with acupoint injection therapy with Vitamin B1) and the control group (51 patients treated with only acupoint stimulation using needles). We performed acupoint injection therapy with Vitamin B1 (0.5 mL of 5% Vitamin B1 was injected in each acupoint using a 5-g syringe) at four main acupoints in the DPN patients of experimental group, and only performed acupoint stimulation for 20 min using needles in the DPN patients of control group.[[14]],[[15]],[[16]]

In that case, the depth of the acupoint injection was 1–1.5 chi. “chi” is a traditional unit of length in the field of acupoint science. Its correct length depends on the corresponding patient and is usually about 2–2.5 cm.[[14]]

Moreover, the angle of the acupoint injection was usually 60°–90° in cases of EX-B3, ST36, and GB34. In case of GB39, the angle was 30°.[[14]]

We compared the changes of DPN symptoms, DPL, changes of tendon reflexes, and electromyographic (EMG) parameters between two groups after 15 days of treatment by means of t-test to evaluate the effectiveness of new acupoint injection therapy with Vitamin B1.

The results are expressed as mean values ± standard deviation, and t-test was used to compare the characteristics between different treatments.

Results

Determination of acupoints for acupoint injection therapy with Vitamin B1

As shown in [[Table 1]], the best acupoint set for performing the acupoint injection therapy with 5% Vitamin B1, includes EX-B3, ST36, GB34, and GB39. It also shows the reasonable period of this therapy can be 10 days. Statistical comparison of three subgroups with the use of Vitamin B1 revealed that acupoints are more important in terms of DPN treatment in one sense.

Table 1: Evaluation of days of pain loss after the acupoint injection therapy with Vitamin B₁

Evaluation of effectiveness of acupoint injection therapy with Vitamin B1

As shown in [[Table 2]], the mean efficiency of the acupoint injection with Vitamin B1 in terms of changes of DPN symptoms was 84.5% that is significantly higher compared with 61.9% of control group.

Table 2: Changes of diabetic peripheral neuropathy symptoms

[[Table 3]] and [[Figure 1]] indicate that the DPL of experimental group was significantly lower than that of control group.

Table 3: Changes of the days of pain loss

Figure 1: Days of pain loss among the patients with diabetic peripheral neuropathy after the acupoint injection therapy with Vitamin B₁

As shown in [[Table 4]] and [[Table 5]], the efficiency rates in terms of patellar reflex and Achilles tendon reflex were 90.9% and 89.1%, respectively. They are significantly higher than those of control group (P < 0.05).

Table 4: Changes of the patellar reflex

Table 5: Changes of the Achilles tendon reflex

In the experimental group, the motor nerve conduction velocities (MCVs) of the tibial nerve were increased significantly, and the H-wave intervals were decreased significantly [[Table 6]].

Table 6: Changes of EMG parameters

Discussion

Recent studies and several guidelines indicated that DPN is not a simple neuropathy but also a serious condition that can cause diabetic foot ulcers and many other complications. They also pointed out that blood glucose must be brought to normal levels to help prevent further neurological damage and progression of neuropathy, and the pain must be treated by some medications including pregabalin or duloxetine.[[7]],[[10]] However, these medications have many serious side effects. Beside the management of blood glucose and the neuropathic pain, there are few treatment approaches to improve the DPN significantly.[[8]],[[11]],[[12]]

The results of our study indicate that EX-B3, ST36, GB34, and GB39 acupoints were the best ones to be injected with 5% Vitamin B1 and when it comes to the treatment period, 10 days intervals seems an optimal time for repeated injections.

The overall efficiency rate in terms of improvement of DPN symptoms including numbness, weakness, convulsions, and night pain was 84.5%, the mean day of the pain loss was 4.4, the efficiency rate in case of patellar reflex was 90.0%, and the efficiency rate in case of Achilles tendon reflex was 89.1%. These parameters were significantly different from those of control group significantly.

Our results indicate that acupoint injection therapy with Vitamin B1 can improve not only the DPN symptoms and syndromes but also abnormal neurological findings including abnormal reflexes.

In addition, therapy can improve the EMG parameters including the MCVs and H-wave intervals in the tibial nerve significantly. It may be due to the neurotrophic action, cholinesterase-inhibiting action, and local stimulating action of Vitamin B1. These results provide a basis for the application of acupoint injection therapy with Vitamin B1 on the DPN patients.[[2]],[[7]],[[13]]

Based on our findings, we “belive this modality of treatment should be utlized more in the management of painful diabetic neuropathy.

Conclusion

Our study suggests that the acupoint injection therapy with vitamin B1 is effective, easy and cost-effective approach for management of DPN as it can shorten the treatment period and improve the DPN symptoms and syndromes, affected exam parameters significantly to improve the quality of life.

Conflict of Interest

There are no conflicts of interest.

Financial support and sponsorship

Nil.

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Publication History

Received: 24 July 2018

Accepted: 08 February 2019

Article published online:
08 June 2022