Spinal cord stimulation promising for diabetic neuropathy pain

Key takeaways:

• Patients implanted with a spinal cord simulation system reported less severe pain from baseline to follow up.
• Treatment also improved sensory nerve function and thermoregulation in extremities.

SAN DIEGO — Treatment with a spinal cord stimulation system reduced pain and restored sensory nerve function in a small cohort of individuals with diabetic peripheral neuropathy, according to a presenter.

“Of more than 800 million adults with diabetes, half of them will develop neuropathy and most of them will develop painful neuropathy,” Gerardo Gutierrez-Gutierrez, MD, from the Infanta Sofia University Hospital in Madrid, Spain, said during a late-breaking session at the American Academy of Neurology Annual Meeting. “These patients will have low quality of life, disability, depression and high medical costs.”

Gutierrez-Gutierrez and colleagues evaluated the efficacy of spinal cord stimulation (SCS) in treating painful diabetic peripheral neuropathy through the INSPIRE clinical trial.

The prospective cohort study initially included 12 patients with telltale “glove-and-stocking” neuropathy that primarily affected their lower extremities but also had an effect on upper extremities. All participants were treated with a four-port SCS and percutaneous leads at the T10 to T12 thoracolumbar area and C5 to T1 cervical area, if needed.

The researchers conducted assessments at baseline before implantation, then planned for assessments at 3-, 6- and 12-month intervals post implantation, which included pain-related metrics such as the Numerical Rating Scale (NRS) and Brief Pain Inventory-Short Form (BPI-SF), the Neuropathic Pain Symptom Inventory (NPSI) and the Utah Early Neuropathy Scale (UENS), as well as skin conductance and thermography on the hands and feet.

At the time of Gutierrez-Gutierrez’s presentation, 11 individuals had received the SCS implant and eight were available for analysis at a follow up of approximately 8 months.

The researchers reported that NRS scores for both lower and upper limbs were significantly reduced (8.6±13 to 2.2±1.4; 6.2±2.0 to 1.9±2.1, respectively), as were BPI-SF scores for pain severity and interference in activities (6.0±2.1 to 2.1±2.6; 6.3±2.7 to 2.7±1.8, respectively) from baseline to follow up.

Data further showed a significant reduction in both NPSI (43±24 to 8±7) and UENS scores (21±8 to 13±10) from baseline to follow up, along with positive trends in recovery of large fiber sensory nerve functions following SCS implantation.

Gutierrez-Gutierrez and fellow researchers also reported improvements in thermoregulatory impairment, with a reduction of approximately 2 degrees Celsius in foot temperature and a moderate increase in electrochemical conductance in patients’ feet following SCS.

“It seems that SCS effectively treats diabetic neuropathy complications and not only pain but also neurological deficits and autonomic symptoms,” Gutierrez-Gutierrez said. “We think that there is a need for further research not only for SCS but for other neuropathies.”