Diabetes can cause nerve damage and have a negative impact on one's quality of life.

Approximately 20% of diabetic patients will develop painful diabetic neuropathy (PDN), a chronic neuropathic pain syndrome. Tingling, numbness, and burning pain in the feet and limbs are common symptoms of PDN. It is commonly diagnosed based on clinical symptoms and/or nerve testing, such as an Electromyography (EMG) or Nerve Conduction Study (NCS), or imaging (e.g. MRI), to rule out other potential causes.

 

Medications:
Anticonvulsants (including gabapentin and pregabalin): 66.6%

Antidepressants (including amitriptyline, duloxetine, nortriptyline, venlafaxine, and desipramine): 17.4%

Opioids (including tramadol, oxycodone, and morphine): 12.7%
Topical agents (e.g., lidocaine, capsaicin): 3.3%

 

Because of inefficacy and/or side effects, most patients discontinue many of these medications 6-12 months after starting them. The majority of patients do not change medications. Current treatment options provide insufficient treatment options and pain relief for many PDN patients.

 

A recent Randomized Clinical Trial (RCT) found that Neuromodulation provided significant benefits.

 

Neuromodulation for PDN consists of a minimally invasive two-part procedure:
1) A test or trial procedure is performed, which consists of inserting a small needle and guiding a small lead to stimulate the nerves upstream of the distal neuropathy at the level of the spine.
2) If the test procedure improves symptoms by 50% or more, the lead wire is connected to an internal pacemaker type device.

Advantages include fewer oral medications and side effects, as well as reduced trauma, blood loss, infection risk, and faster recovery due to the minimally invasive nature.