Spinal cord stimulation reduces up to 80% of diabetic peripheral neuropathy pain

 

Key Take-Aways:

• 50% of adults with diabetes will experience diabetic peripheral neuropathy

• Less than 1/3 of DPN cases are effectively treated with medical management

• Spinal cord stimulation was approved by the FDA in 2023 for the treatment of DPN

• Medical management with SCS reduced hospitalizations 50%

 

Of the nearly 15% of American adults with diabetes, half will experience diabetic peripheral neuropathy often leading to chronic and debilitating pain, infection, ulceration and eventual amputation. Less than 1/3 of patients achieve effective pain control, leading to poor quality of life. Adverse cardiac events and hospitalization are common in this patient population.

Primary care providers, endocrinologists, podiatrists and pain management physicians often manage these patients, traditionally with medications including anticonvulsants, antidepressants and sometimes opioids. Yet, studies show more than half of patients discontinue medications within the first six months because of adverse effects or lack of efficacy, or both.

The FDA approved spinal cord stimulation (SCS) for the treatment of DPN in 2023, with plentiful evidence of its effectiveness based on use with other forms of PN. Beyond the lack of effective medical management for this condition, another compelling reason for use of SCS is a new study that compared hospitalization rates of patients treated with conventional medical management (CMM) vs. patients treated with CMM plus high-frequency (10kHz) SCS.

This study found that CMM plus high-frequency SCS for the treatment of painful diabetic neuropathy resulted in a 50% reduction in hospitalizations at the 6-month mark, with 1/3 lower healthcare costs ($6,300 vs $9,532).

Properly selected patients who have successful SCS trials experience up to 80% reduction in pain. The result appears to be long-term, with one study showing continued pain relief 8 years after implantation.

Given the high rate of refractory cases, SCS should be considered early in treatment planning to avoid unnecessary pain, decreased quality of life and potential long-term comorbidities. The FDA has recognized the limitations of CMM and established low hurdles for SCS consideration as outlined below:

Patient Inclusion Criteria for Spinal Cord Stimulation

• Painful neuropathy diagnosis with symptoms ≥ 6 months
• Refractory to medical treatment with gabapentin or pregabalin, and at least 1 other class of analgesic
• Lower limb pain intensity of 5 or more on a visual analogue scale (out of 10)

Patient Exclusion Criteria:

• Hemoglobin A1c greater than 10%
• BMI greater than 45
• Daily opioid use greater than 120 mg morphine equivalents
• Upper limb pain intensity of 3 or more on a visual analogue scale (out of 10)

REFERRAL INFORMATION

At Neurosurgery One, we have seen great success for the treatment of PPN with high-frequency SCS. We have established a clinic staffed by certified physician assistants to assist in performing the initial assessment and ordering the MRI and psychological evaluation. We carefully screen patients for optimal selection for SCS trials, with 80-90% of our patients experiencing satisfactory pain reduction and choosing implantation.

As a private neurosurgical practice, we are highly attentive to referring provider preferences. We are willing to manage patients independently through this process, including handling all insurance authorizations, and continue to see these patients for adjustments but returning all patients to referring providers at the conclusion of implantation. Or we can co-manage patients with referring providers, sending referring providers as much documentation and clinical notes as desired.

For more information, please call 720-638-7500.

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