Spinal Cord Stimulation Reduces Pain in Diabetic Polyneuropathy

Patients with painful diabetic polyneuropathy (PDPN), experienced by up to one-quarter of individuals with diabetes, were found to benefit from spinal cord stimulation (SCS) with a maximum duration of symptomatic pain relief of 60 months, according to research published in Diabetes Care.¹

The prospective, multicenter study found that after 5 years, 55% of patients achieved treatment success. The researchers also found that 80% of subjects with a permanent SCS device continued to use it 5 years later.

Investigators evaluated the severity of neuropathy in 48 patients with PDPN using the Michigan Diabetic Neuropathy Score (MDNS) with a goal of examining SCS treatment success, failure, and complications in patients with PDPN in the lower limbs. They also analyzed numerical rating scale (NRS) score for pain, Patient’s Global Impression of Change (PGIC), and treatment success (50% reduction of NRS score or significant PGIC) during the 5-year follow-up period.

Before inclusion in the study, all patients were treated according to international guidelines based on the evidence-based treatment algorithm for the management of diabetic peripheral neuropathic pain established by Jensen et al.²

Median length of treatment was 60 months and ranged from 1 month to 60 months.  After 5 years, 55% of patients had treatment success, and 80% of people with a permanent SCS still used their device. People with a higher Michigan Diabetic Neuropathy Score (MDMS) were more likely to have unsuccessful treatment and subsequent removal of the SCS device during the 5-year follow-up period (hazard ratio [HR] 3.9 [95% CI, 1.3-11.6]; P=.014].

“SCS is successful in reducing chronic pain symptoms in the lower extremities of patients with PDPN up to 5 years after initiation of treatment,” the investigators concluded.

This study was limited by the use of data related to treatment success that were based on those patients who continued to use their SCS device and did not include those who had their device removed and were not included in the follow-up. Another study limitation was the lack of a control group.

References

1. van Beek M, Geurts JW, Slangen R, et al. Severity of neuropathy is associated with long-term spinal cord stimulation outcome in painful diabetic peripheral neuropathy: five-year follow-up of a prospective two-center clinical trial [published online November 6, 2017]. Diabetes Care. https://doi.org/10.2337/dc17-0983
2. Jensen TS, Backonja M-M, Hernandez Jimenez S, Tesfaye S, Valensi P, Ziegler D. New perspectives on the management of diabetic peripheral neuropathic pain. Diab Vasc Dis Res. 2006;3(2):108-119.