Background: Diabetic peripheral neuropathy (DPN) is a prevalent complication of type 2 diabetes (T2D), associated with microvascular dysfunction and significant morbidity. Exercise is a cornerstone of diabetes care and has demonstrated benefits for neuropathic pain, whereas Intraneural Facilitation^TM (INF^®) therapy is a manual technique designed to enhance intraneural perfusion. This study compared the effects of INF^® therapy and exercise on neuropathic pain qualities in adults with DPN. Methods: In this single-blinded randomized controlled trial, 38 adults with T2D and moderate to severe DPN were randomized to INF^® therapy (n = 20) or standardized exercise (n = 18). Participants completed nine 60-min sessions over a period of six weeks. Neuropathic pain qualities were assessed using the Pain Quality Assessment Scale (PQAS) at baseline and post-treatment. Paired t tests, independent t tests, and linear mixed models adjusted for age and body-mass index (BMI) evaluated within- and between-group changes. Results: Both treatment groups demonstrated significant reductions in total PQAS scores (p = 0.001). INF^® therapy produced improvements across paroxysmal, superficial, and deep pain domains, with reductions in descriptors such as shooting, sharp, electrical, numb, and unpleasant pain. Exercise led to selective improvements, including sharp, electrical, numb, sensitive, and unpleasant sensations associated with pain. Between-group analyses and mixed-effects models revealed no significant differences after adjusting for confounding factors. Conclusions: Both INF^® therapy and exercise improved neuropathic pain qualities in adults with DPN. INF^® therapy demonstrated broader within-group effects, suggesting its potential as a passive adjunct or alternative for patients unable to tolerate active exercise.

This study compared Intraneural Facilitation (INF ^® ) therapy and standard physical therapy (PT) in preventing chemotherapy-induced peripheral neuropathy (CIPN) in women with newly diagnosed breast and gynecologic cancer. Thirty-eight women undergoing platinum and/or taxane-based chemotherapy, without prior peripheral neuropathy, were randomized into INF ^® therapy (n = 20) and PT (n = 18). Treatments lasted 45 minutes, twice weekly, for 6 weeks. Neuropathy severity was evaluated using the Pain Quality Assessment Scale. Assessments were at baseline, 3 weeks, 6 weeks, and 3 months post-intervention. Acceptability, burden, and satisfaction were evaluated after 6 weeks. Among 38 patients, 12 (32%) experienced CIPN, with mean pain scores remaining mild (≤3) and no pharmacotherapy required until week 6. No adverse events were reported from the interventions. The INF ^® therapy arm showed significant changes in numbness ( F = 6.030, P = .001, partial η ² = 0.262) after week 6, while the PT arm showed significant changes in numbness ( Z = −2.39, P = .017), tingling ( Z = −2.84, P = .004), cramping ( Z = −2.120, P = .034), surface pain ( Z = −2.75, P = .006), and deep pain ( Z = −1.99, P = .046) between weeks 3 and 6. Nearly 80% of patients completed chemotherapy cycles with an average relative dose intensity of 90.4% (INF ^® therapy: 87.73% vs PT: 73.44%). Ninety-four percent of patients were satisfied with their care, accepted the treatments, and perceived them as a low burden. The results demonstrated that INF ^® therapy and PT are feasible options for CIPN, improving treatment adherence, outcomes, and quality of life for women with newly diagnosed breast and gynecological cancers. Trial Registration - The study was pre-registered on ClinicalTrials.gov (NCT03272919). August 8, 2017.