Dual Field PEMF Therapy in Lower Extremity Painful Diabetic Distal Symmetric Peripheral Neuropathy

Eligible subjects will be entered into a 14-day ePRO diary run-in period to collect average
baseline pain scores related to their diabetic neuropathy in the lower extremities, diary
compliance, and analgesic consumption (maintenance and prn prescribed peripheral neuropathic
pain medication pill counts). Subjects will collect electronic patient-reported outcome
(ePRO) data each morning around the same time during the run-in period.

Subjects will return to the clinic at Baseline (Day 0) for review of eligibility, diary
compliance, average baseline diabetic neuropathic pain score of ≥4 and <9, and review of
stable analgesic pain consumption profile during the 14-day run-in period. Qualified subjects
based on diary compliance and average pain score will be randomized 1:1 (active: sham) and
will be instructed to self-treat twice daily for 120 days. Subjects will record electronic
patient-reported outcome (ePRO) data following each morning treatment for 120 days. Subjects
consenting to distal thigh and distal leg skin biopsies during the Screening visit will have
biopsies collected and sent to the central laboratory for assessment. All subjects will have
baseline assessments conducted.

Subjects will receive a telephone call at Day 7 to ensure compliance to treatment and diary
completion, provide follow-up information on the biopsy sites (if applicable), complete a
blinding assessment as well as be assessed for safety and concomitant medication changes.

At Month 1 subjects will return to the clinic for evaluation of safety, concomitant
medication changes, review device usage and ePRO diary completion, and Patient Global
Impression (PGI). Treatment satisfaction will also be assessed.

At Month 2 subjects will return to the clinic for evaluation of safety, concomitant
medication changes, treatment satisfaction, review of device usage (reports will be supplied
to the site) and ePRO diary completion, quality of life outcomes (WPAIQ and NeuroQoL),
Patient Global Impression (PGI), and interim visit measurements of SPP.

At Month 3, subjects will return to the clinic for evaluation of safety, concomitant
medication changes, review device usage (reports will be supplied to the site) and ePRO diary
completion, and Patient Global Impression (PGI). Treatment satisfaction will also be
assessed.

At Month 4 (end of Part A / start of Part B), subjects will return to the clinic for
evaluation of safety, treatment satisfaction, review of device usage (reports will be
supplied to the site), HbA1c, concomitant medication changes, weight, quality of life
outcomes (WPAIQ and NeuroQoL), PGI, final measurements of SPP, NCS, QST and be assessed to
determine their Toronto Clinical Neuropathy Score. Those subjects who consented and had
biopsies collected at the Enrollment visit, will have their end of study biopsies during this
visit and samples sent directly to the central laboratory for assessment. Subjects will
return the study device and complete a blinding assessment.

Subjects that complete Part A will continue into the open-label extension period (Part B).
All subjects will be reconsented if not completed at a prior visit and given an open-label
active device. Subjects will record ePRO data for one week prior to the Month 6, 8, 10, and
12 visits following each morning treatment. Subjects will be reminded of the150-day (Month 5)
phone call.

At Month 5, subjects will receive a telephone call to ensure compliance to treatment, and to
be assessed for safety and concomitant medication changes.

At Month 6, subjects will receive a telephone call to ensure treatment compliance and
collection of diary data, and to assess safety and concomitant medication changes.

At Month 7, subjects will receive a telephone call to ensure treatment compliance, and to
assess safety and concomitant medication changes.

At Month 8, subjects will return to the clinic for evaluation of safety, measure QST,
treatment satisfaction, review of device usage and collection of diary data, concomitant
medication changes, quality of life outcomes (NeuroQoL), and PGI.

At Month 9, subjects will receive a telephone call to ensure treatment compliance, and to
assess safety and concomitant medication changes.

At Month 10, subjects will receive a telephone call to ensure treatment compliance and
collection of diary data, and to assess safety and concomitant medication changes.

At Month 11, subjects will receive a telephone call to ensure treatment compliance, and to
assess safety and concomitant medication changes.

At Month 12 (end of open-label treatment extension), subjects will return to the clinic for
evaluation of safety, weight, QST, NCS, TCNSS, PGI, treatment satisfaction, review of device
usage and collection of diary data, concomitant medication changes, quality of life outcomes
(NeuroQoL), and will return the study device. Subjects who consented and had biopsies
collected at the 4 Month visit, will have their end of study biopsies performed during this
visit.

Inclusion Criteria:

- Type 1 or Type 2 diabetes

- Pain attributed to symmetrical lower extremity diabetic peripheral neuropathy for at
least 6 months

- DPN pain over the preceding 24 hours is ≥4 and <9 based on the 11-point NPRS (0-10)

- 22 to 80 years of age

- On stable diabetes treatment

- HbA1c less than or equal to 10%

- No recent changes to analgesic prescriptions

- ABI of ≥0.8 to ≤1.3

- Walks independently

- Willing and able to give consent

- If female, must be post-menopausal, surgically sterile, abstinent or practicing an
effective method of birth control

- Can access an internet browser or smart phone

To be randomized after the 14-day run-in period, average pain (NPRS) must be ≥ 4 and < 9
over preceding 7 days and subject must be 70% compliant with ePRO assessments (electronic
diary)

Exclusion Criteria:

- Active, open ulcer on either extremity

- Significant peripheral vascular disease

- Venous insufficiency

- History of solid organ transplant or severe renal disease

- Diagnosed with a non-diabetic cause of chronic neuropathy

- Previous or current history of primary or tertiary hyperparathyroidism, hypercalcemia,
psychiatric disorder, alcohol dependency, Hepatitis B or C, or HIV infection

- Significant cardiovascular disease

- Uncontrolled medical illness

- Requires or anticipates the need for surgery during the study

- Total foot depth of >8 cm

- Has received any investigational drug or device within 30 days

- Has used systemic corticosteroids within 3 months

- History of malignancy within 5 years in treatment area

- A psychiatric disorder of sufficient severity

- Receiving prn narcotic medications

- History of drug or alcohol abuse within 1 year

- Implanted pacemaker, defibrillator, neurostimulator, spinal cord stimulator, bone
stimulator, cochlear implant, or other implanted device with an implanted metal
lead(s0

- Pregnant or planning to become pregnant

- Previous treatment with Provant Therapy

- Unwilling to follow instructions or comply with study instructions

- Pain from any other source that could confuse DPN pain assessment

- Clinically significant foot deformity

- Skin condition that could alter peripheral sensations

- Previous surgery to the spine or lower extremity with residual symptoms of pain or
difficulty with movement.

- Clinically significant arthropathy