Avaliação da marcha e percepção de dor em pacientes com neuropatia periférica diabética após aplicação de vácuo terapia associada à laserterapia na região plantar – ensaio clínico randomizado crossover

Abstract

The peripheral nerve damage associated with Diabetes Mellitus is known as Diabetic Peripheral Neuropathy and is present in 50% of cases of diabetes. This clinical condition results in predominantly distal sensory and motor impairment that, together with pain of neuropathic origin, cause serious difficulties in relation to gait, providing a greater chance of injuries due to falls and other complications, which can lead to amputation of the affected limb. Pharmacological treatment mainly involves drugs to control neuropathic pain and, although this is a widely used resource, it has several side effects in addition to its high cost. Vacum laser therapy is an intervention technique that combines the analgesic, anti-inflammatory and tissue repair effects of low-intensity laser therapy with the effects of hypopressive therapy, resulting in pain relief. However, there is a scarcity in the literature of studies with the application of this resource in peripheral neuropathies, especially those resulting from diabetes. The aim of this study was to analyze the effect of vacuum laser therapy on the plantar region of patients with type II diabetic neuropathy. To this end, a randomized, controlled, crossover clinical trial was carried out with 20 individuals with a clinical diagnosis of type II diabetes and who had a score above 3 on the scale of impairments and neuropathic symptoms. The volunteers were randomly distributed into two groups, the intervention group (IG) receiving treatment with vacuum laser therapy 3 times a week, for a period of 4 weeks, totaling 10 sessions; and the control group (CG), which received guidance on foot care. The Numerical Pain Rating Scale and gait assessment through an electronic baropodometry and stabilometry platform were used for the evaluation. The study group, treated with vacuum laser therapy, presented lower pain scores (2.11±2.39) compared to the control group (5.28±2.86) (t (30) = 3.41, p < 0.00), where there was a high difference in effect size (1.20) and power (0.90). For the study group, pain scores decreased in the post-intervention (p<0.00 (2.11 ± 2.40) compared to pre-intervention (6.89 ± 2.27) (t (30) = 3 .41, p < 0.00) For the variables related to gait analysis, significant differences were observed in the assessment between groups for the left foot area, both pre-intervention (p=0.003) and post-intervention (p=0.00), with the intervention group presenting lower mean values in both cases. This result was also

observed for the right foot area, for which significantly lower mean values were observed for the intervention group, both in the pre-intervention (p=0.00) and post- intervention (p=0.001). No significant differences were observed in the other variables analyzed. These results demonstrate a positive effect of vacuum laser therapy on pain relief, but not on the variables gait, in individuals with peripheral neuropathy resulting from type II diabetes mellitus.