To evaluate the efficacy of vagus nerve stimulation in reducing neuropathic pain, symptom severity, electrophysiological studies and functional outcomes in patients with diabetic peripheral neuropathy.

Diabetes is a major global health problem affecting half a billion people worldwide. Its global prevalence is rising at an alarming rate and has been forecast to reach 700 million by 2045. Diabetic neuropathy is an important and common complication of diabetes, with a lifetime prevalence of more than 50% among people with diabetes. Diabetic neuropathy is an insidious and often disabling disease.

Sensory symptoms are diverse, ranging from numbness to dysesthesia, pain and allodynia, and typically begin in the feet and spread proximally. Motor function can also be affected, preventing patients from engaging in activities of daily living. More recently, the considerable psychosocial and quality of life impacts of Diabetic neuropathy have been recognized. Furthermore, Diabetic neuropathy is a major risk factor for diabetic foot ulceration, which is an independent risk factor for lower limb amputation and mortality. The associated economic burden is high; the annual cost of managing Diabetic neuropathy exceeds billions of dollars in different countries .

Current treatments are purely symptomatic and the most commonly recommended first-line agents include anticonvulsants (gabapentin and pregabalin), serotonin-noradrenaline reuptake inhibitors, and tricyclic antidepressants. Unfortunately, the therapeutic effect may offset by intolerable adverse effects.

In this study, evidence for a potentially effective, non-pharmacological treatment option for Diabetic neuropathy will be provided. Positive findings could lead to improved management strategies for Diabetic neuropathy, reducing the burden of chronic pain and enhancing the overall well-being of diabetic patients. Vagus nerve stimulation has emerged as a potential intervention, offering promise in modulating neuropathic pain and improving functional outcomes.

Furthermore, understanding the mechanisms through which transcutaneous Vagus nerve stimulation affects pain and nerve function may offer insights into broader applications of vagus nerve stimulation in other neuropathic conditions. This research could pave the way for future studies and clinical applications, positioning transcutaneous Vagus nerve stimulation as a valuable tool in the multidisciplinary approach to managing diabetic peripheral neuropathy.

Inclusion Criteria

• Thirty patients diagnosed with diabetic neuropathy of both genders.
• Age range between 45 and 60 years.
• Presence of numbness and/or pain in the feet with no other identifiable cause.
• Pain characterized as stabbing, electric shock-like, or burning in nature.
• Presence of glove-stocking sensory changes and abnormal sensations in the distal lower limbs.
• Ability to ambulate independently without assistance.
• Patients under full medical control.
• Hemoglobin A1c levels ranging from 6.5% to 7%.
• History of diabetes mellitus for more than 5 years.

Exclusion Criteria

• Implantation of cardiac pacemakers or other electrical stimulation devices.
• Presence of sinus bradycardia, sick sinus syndrome, or other cardiac arrhythmias.
• Lumbar radiculopathy.
• Psychiatric or mental disorders or history of seizures.
• Visual or auditory impairments or tremors affecting balance.
• Presence of other neuromuscular disorders.
• Foot deformities or active foot ulcers.
• History of lower limb surgical operations.