Background and purpose: Mechanosensitivity of peripheral nerves was earlier demonstrated in animal models and in experimental human models of diabetic neuropathy and also in asymptomatic human subjects. The purpose of this study was to assess the immediate effects of nerve sliders and nerve massage on vibration perception thresholds (VPT), heat perception thresholds (HPT) and cooling perception thresholds (CPT) in patients with painful diabetic peripheral neuropathy.,Materials and methods: The study was an observer-blinded pilot randomized sham-controlled clinical trial with concealed allocation on 34 patients (22 male, 12 female) of mean age 53.86 ± 9.85 years with type-2 diabetes mellitus, neuropathic pain for more than one-year, VPT > 25 volts in feet and positive lower extremity neurodynamic testing in bilateral lower limbs suggestive of distal symmetric type of diabetic neuropathy. The tester administered nerve sliders and nerve massage to one lower limb while sham intervention of passive joint movements was performed for the other limb. The choice of first limb was chosen randomly and block randomization was performed to minimize between-side confounding differences. The three outcomes of VPT, HPT and CPT were assessed pre, immediate post and 15 min-post intervention on both feet using a biothesiometer., Data analysis and results: The data was analyzed using repeated measures analysis of variance at 95% confidence interval using SPSS 12.0.1 for Windows. Secondary analysis was done using independent t-test for gender and choice of first side. The experimental side had a greater reduction of VPT (12.40 ± 4.90 volts), HPT (7.63 ± 5.18 degree Celsius) and CPT (8.02 ± 5.97 degree Celsius) from pre-treatment to 15- min post-treatment compared to the sham side (p<.05). The changes between immediate post-treatment and 15- min post-treatment was not significant (p>.05) for all three measurements., Conclusion: Neurodynamic mobilization comprising of nerve sliders and nerve massage was effective on short-term in reducing VPT, HPT and CPT in patients with painful diabetic peripheral neuropathy compared to a sham intervention. These immediate effects were maintained at 15 min post-treatment.

Key words: Neurodynamics, mechanosensitivity, diabetic neuropathy, manual therapy, quantitative sensory testing.