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Tonic-spinal cord stimulation (t-SCS),
high-frequency SCS, burst SCS, and dorsal root ganglion stimulation (DRGS) may
be beneficial to treat patients with painful diabetic neuropathy (PDN).
The findings of a study published in 'Neuromodulation' depicted that t-SCS is the established standard of treatment for medication refractory severe PDN. But, other novel stimulation modalities like high-frequency SCS, burst SCS, and DRGS are rising as promising therapeutics yielding comparable pain benefits, but only with few cases published.
This systematic review and meta-analysis assessed the pain outcomes of patients suffering from painful diabetic neuropathy and receiving any type of invasive neuromodulation to treat neuropathic pain. Database like MEDLINE and Embase were explored for relevant studies without the restriction of language. All study types were incorporated.
Two investigators independently screened publications, followed by extraction of the data. Quantitative meta-analysis was carried out with pain scores converted to a standard 100-point scale. Utilizing the inverse variance method, pooling of the randomized controlled trial (RCT) scores was done and states as mean differences.
It was found that for managing patients suffering from debilitating PDN, safe, efficacious, and lasting surgical pain management options are available. The RCTs of t-SCS displayed more alleviation of pain when compared with the best medical treatment at 6 months (intention-to-treat: 38/100).
According to the per-protocol assessment, the case series of DRGS and t-SCS displayed improvement by 55 and 56 respectively, at 12 months. For t-SCS, the risk of infection, the rate of failing a therapeutic stimulation trial, and the rate of lead problems that needed surgery to resolve are shown in the below table 1:
Both burst SCS and high-frequency SCS demonstrated efficacy, with only a few patients evaluated. RCTs are ongoing to explore their relative merits, concluded the study authors.
Neuromodulation
Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis
Ashley L B Raghu et al.
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