Research Article

The Effectiveness of Leech Therapy in the Severity of Diabetic Neuropathy: A Randomized Controlled Trial

Abstract

Diabetic peripheral neuropathy is one of the most common causes of disability in diabetic patients. Applying a method to achieve the highest therapeutic effect in patients is desirable. Therefore, this study aimed to evaluate the impact of leech therapy on diabetic neuropathy of lower limbs in comparison to gabapentin as a standard method. This randomized controlled parallel-group clinical trial was conducted among 40 patients with type II diabetes who were diagnosed with lower limb diabetic neuropathy and referred to specialized outpatient clinics in Babol, Mazandaran province, Iran from 23 September 2020 to 17 March 2021. The patients were randomly divided into two groups. One group was treated with leech therapy and the other group was treated with gabapentin as the standard method. The severity of neuropathy was assessed every 15 days until the 45th day. The Visual Analog Scale (VAS), Neuropathy Symptom Score (NSS), Neuropathy Disability Score (NDS), and Nerve Conduction Velocity (NCV), and Electromyography (EMG) were used for assessing the study outcomes. The repeated measure and Friedman tests were used by SPSS.V.23.  The results of our study indicated that pain (P value:0.03), numbness (P value˂0.0001), and paranesthesia (P value:0.01) significantly reduced in patients undergoing leech therapy versus patients taking gabapentin on the 45th day. The total NSS (P value˂0.0001) and total NDS (P value˂0.0001) improved significantly for patients with leech therapy over 45 days compared to the patients with gabapentin. The results of our study showed that using leech therapy for patients with diabetic neuropathy was more effective in improving clinical symptoms and the functions of lower limb muscles and nerves in comparison to gabapentin. The severity and symptoms of neuropathy greatly improved for the patients treated with leech therapy versus patients taking gabapentin.

Yamany AA, Sayed HM. Effect of low-level laser therapy on the neurovascular function of diabetic peripheral neuropathy. J Adv Res 2012;3:21-28.

Menz HB, Lord SR, St George R, Fitzpatrick RC. Walking stability and sensorimotor function in older people with diabetic peripheral neuropathy. Arch Phys Med Rehabil 2004;85:245-252.

Kasim K, Amar M, El Sadek AA, Gawad SA. Peripheral neuropathy in type-II diabetic patients attending diabetic clinics in Al-Azhar University Hospitals, Egypt. Int J Diabetes Mellit 2010;2:20-23.

Schreiber AK, Nones CF, Reis RC, Chichorro JG, Cunha JM. Diabetic neuropathic pain: physiopathology and treatment. World J Diabetes 2015;6:432.

Ghafarzadegan R, Malekhosseini A, Saeedi M, Jadidi A, Rezaee Ashtiani A. The effects of lower limb vibration therapy on neuropathy pain in diabetic patients. Complement Med J Fac Nurs Midwifery 2014;4:614-623.

Zubair M. Diabetic Foot Ulcer: An Update: Springer Nature 2020.

Lone AH, Ahmad T, Anwar M, Habib S, Sofi G, et al. Leech therapy-a holistic approach of treatment in Unani (Greeko-Arab) medicine. Anc Sci Life 2011;31:31.

Zaidi SA. Unani treatment and leech therapy saved the diabetic foot of a patient from amputation. Int Wound J 2016;13:263-264.

Laila S, Fatemeh E, Lida B. Treatment of diabetic foot ulcer with medicinal leech therapy and honey curcumin dressing: a case report. Tradit Med Res 2019;4:338.

Ansari S, Nil F, Jabeen A, Sultana A, Khan QA. Post-auricular leech therapy reduced headache & migraine days in chronic migraine. J Drug Deliv Ther 2019;9:75-80.

Hajtalebi H, Khani-Iurigh H, Hajtalebi H-R. Treatment of diabetic foot ulcer in a 58-year-old turkman patient based on Iranian traditional medicine. Tradit Integr Med 2016;1:151-159.

Amani L, Fadaei F, Shams Ardakani M, Mirabzadeh Ardakani M, Sadati Lamardi SN, et al. Leech therapy in skin conditions from the viewpoints of Avicenna and modern medicine: Historical review, current applications, and future recommendations. Iran J Dermatol 2020;23:168-175.

Barzegar A, Azizi A, Faridi P, Mohagheghzadeh A. Leech therapy in Iranian traditional medicine. Complement Med Res 2015;22:50-53.

Jang H-K, Heo D-S. The literature review of Leech therapy. J Pharmacopunct 2010;13:103-120.

Karnchanasorn R, Huang J, Ou H-Y, Feng W, Chuang L-M, et al. Comparison of the current diagnostic criterion of HbA1c with fasting and 2-hour plasma glucose concentration. J Diabetes Res 2016;2016:6195494.

Hanson RL, Nelson RG, McCance DR, Beart JA, Charles MA, et al. Comparison of screening tests for non-insulin-dependent diabetes mellitus. Arch Intern Med 1993;153:2133-2140.

Dyck PJ, Albers JW, Andersen H, Arezzo JC, Biessels G-J, et al. Diabetic polyneuropathies: update on research definition, diagnostic criteria and estimation of severity. Diabetes Metab Res Rev 2011;27:620-628.

Kiani J, Moghimbeigi A, Azizkhani H, Kosarifard S. The prevalence and associated risk factors of peripheral diabetic neuropathy in Hamedan, Iran. Arch Iran Med 2013;16:17-19.

Jia WP, Shen Q, Bao YQ, Lu JX, Li M, et al. Evaluation of the four simple methods in the diagnosis of diabetic peripheral neuropathy. Zhonghua Yi Xue Za Zhi 2006;86:2707-2710.

Mørkrid K, Ali L, Hussain A. Risk factors and prevalence of diabetic peripheral neuropathy: A study of type 2 diabetic outpatients in Bangladesh. Int J Diabetes Dev Ctries 2010;30:11-17.

Barzegar A, Azizi A, Faridi P, Mohagheghzadeh A. Leech therapy in Iranian traditional medicine. Forschende Komplementarmedizin (2006). 2015;22:50-53.

Zaidi SMA. Unani treatment and leech therapy saved the diabetic foot of a patient from amputation. Int Wound J 2016;13:263-264.

Hajtalebi H, Khani Iurigh H, Hajtalebi H. Investigating the treatment status of 10 patients with second and third-degree diabetic foot ulcers based on the therapeutic protocols of Iranian traditional medicine in Bojnurd from 2015-2016. Asian J Clin Case Rep Trad Altern Med 2017;1:55-64.

Khan F, Ansari AN, Nayab M. Management of diabetic neuropathy by irsal-e-alaq (hirudotheraphy): a case report. European J Pharm Med Res 2020;7:667-671.

Nouri M, Karimi-Yarandi K, Etezadi F, Amirjamshidi A. Leech therapy for pain relief: Rational behind a notion. Surg Neurol Int 2012;3:159-.

Rai PK, Singh AK, Singh OP, Rai NP, Dwivedi AK. Efficacy of leech therapy in the management of osteoarthritis (Sandhivata). Ayu 2011;32:213-217.

Kalender ME, Comez G, Sevinc A, Dirier A, Camci C. Leech therapy for symptomatic relief of cancer pain. Pain Med 2010;11:443-445.

Koeppen D, Aurich M, Rampp T. Medicinal leech therapy in pain syndromes: a narrative review. Wien Med Wochenschr 2014;164:95-102.

Michalsen A, Stefanie K, Ldtke R, Moebus S, Spahn G, et al. Effectiveness of leech therapy in osteoarthritis of the knee. Ann Intern Med 2003;139:724-730.

Michalsen A, Roth M, Dobos GJ. Medicinal Leech Therapy: Thieme 2011.

Hemmati AA, Aarefat S, Ghiyami SH, Sadeghi A. The Effect of leech therapy on Blood Lactate Level and Pain Perception Index in Athletes following an Exhausting Physical Activity. thums-jms. 2019;7(3):1-11.

Baskova IP, Aguejouf OM, Azougagh-Oualane F, Zavalova LL, Basanova AV, et al. Arterial antithrombotic effect of piyav1t, the novel pharmacological preparation from the medicinal leech, and of its components, prostanoids and enzyme destabilise. Thromb Res 1995;77:483-492.

Rigbi M, Levy H, Eldor A, Iraqi F, Teitelbaum M, et al. The saliva of the medicinal leech Hirudo medicinalis—II. Inhibition of platelet aggregation and leukocyte activity and examination of reputed anesthetic effects. Comp Biochem Physiol C Comp Pharmacol 1987;88:95-98.

Singh AP. Medicinal leech therapy (hirudotherapy): a brief overview. Complement Ther Clin Pract 2010;16:213-215.

La Spina I, Porazzi D, Maggiolo F, Bottura P, Suter F. Gabapentin in painful HIV-related neuropathy: a report of 19 patients, preliminary observations. Eur J Neurol 2001;8:71-75.

Atalay H, Solak Y, Biyik Z, Gaipov A, Guney F, et al. Cross-over, open-label trial of the effects of gabapentin versus pregabalin on painful peripheral neuropathy and health-related quality of life in haemodialysis patients. Clin Drug Investig 2013;33:401-408.

Khasbage S, Shukla R, Sharma P, Singh S. A randomized control trial of duloxetine and gabapentin in painful diabetic neuropathy. J Diabetes 2021;13:532-541.

Abdel-Wahhab KG, Daoud EM, El Gendy A, Mourad HH, Mannaa FA, et al. Efficiencies of low-level laser therapy (lllt) and gabapentin in the management of peripheral neuropathy: diabetic neuropathy. Appl Biochem Biotechnol 2018;186:161-173.

Nasrabadi Z, Rakhshani MH, Ebadi H, Akbarzadeh R. Comparison of the effect of gabapentin and evening primrose oil on peripheral neuropathy pain in patients with type 2 diabetes. Avicenna J Clin Med 2019;26:5-11.

Heckmann JG, Dütsch M, Neundörfer B, Dütsch F, Hartung U. Leech therapy in the treatment of median nerve compression due to forearm haematoma. J Neurol Neurosurg Psychiatry 2005;76:1465.

Schenker M, Murray A, Kay SPJ. Leech therapy in the treatment of median nerve compression due to forearm hematoma. J Neurol Neurosurg Psychiatry 2006;77:799.

Hadi RA, Mohammed MM, Salman IN. Studying the effect of adding alpha lipoic acid to gabapentin to improve nerve conduction velocity and glycemic control of patients with diabetic neuropathy (sample of the Iraqi population). Al-Mustansiriyah Journal of Pharmaceutical Sciences (AJPS). 2020;20:55-62.

Files
IssueVol 7, No 4, 2022 QRcode
SectionResearch Article(s)
DOI https://doi.org/10.18502/tim.v7i4.11488
Keywords
Diabetes Gabapentin Iran Leech therapy Neuropathy Persian medicine

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Alemi F, Azimi M, Moeini R, Shirafkan H, Bayani M, Mojahedi M, Tajadini H. The Effectiveness of Leech Therapy in the Severity of Diabetic Neuropathy: A Randomized Controlled Trial. Trad Integr Med. 2022;7(4):375-385.