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David A. Arnall, PT, PhD, is not what one would call an early adopter. A self-proclaimed professional skeptic, he is a believer in evidence-based medicine who, under most circumstances, puts no stock in fledgling therapies until their efficacy has been validated through rigorous scientific study.
The use of infrared light therapy for peripheral neuropathy is not what one would call evidence-based medicine-certainly not if one works for the Centers for Medicare and Medicaid Services. In an October decision memorandum, CMS ruled that the handful of studies were sufficient to conclude that the therapy was neither reasonable nor necessary for that indication. Most of the studies were retrospective or had other limitations; the single well-designed randomized, controlled trial found no significant benefit.
And yet Arnall, the skeptic, will tell anyone who will listen that he believes infrared light therapy can restore sensation and reduce pain in patients with diabetic peripheral neuropathy.
Indeed, this opinion has something to do with scientific evidence: Arnall conducted a 22-patient study in 2004 in Spain that found protective sensation significantly improved in neuropathic feet treated with pulsed infrared light therapy (PILT) compared with nonsignificant improvements or deterioration in untreated feet. In lieu of a placebo treatment in the study, one of each patient's feet was left untreated as a within-subject control. The results were published in the May 2006 issue of the European journal Acta Diabetologica.
But Arnall's opinion is also grounded in personal experience. Having lived with diabetes for 20 years, he had tried every available therapeutic option, including decompression surgery, to relieve his peripheral neuropathy with no luck. Infrared light therapy, he says, succeeded where all the other treatments had failed.
"My neuropathies were resolved," said Arnall, who is a professor and chair of physical therapy at East Tennessee State University in Johnson City. "Now I'm a believer, not only because of the positive outcomes of the Spanish diabetes patients, but also because of my own case. This is one modality that is spectacular."
Arnall isn't alone in having had a positive experience with infrared light therapy for peripheral neuropathy. The CMS memo authors received 1315 comments during the initial public comment period, and all but three supported the use of the therapy. Five of those supporters were,...