Spinal Cord Stimulation for Diabetic Peripheral Neuropathy (DPN)
What It Is
Spinal Cord Stimulation (SCS) is a minimally invasive, FDA-approved treatment that delivers mild electrical pulses to the spinal cord through a small implanted device. These pulses interfere with the transmission of pain signals, preventing them from reaching the brain and thereby reducing the sensation of pain. The system typically consists of an implanted pulse generator (battery) and thin wires (leads) placed in the epidural space near the spinal cord.
What It Treats
SCS is used to treat painful diabetic peripheral neuropathy (DPN), a common complication of diabetes that results from nerve damage, most often in the feet and legs. Symptoms include:
Burning, tingling, or stabbing pain
Numbness or hypersensitivity
Pain that worsens at night
Poor response to medications
SCS is recommended for patients whose symptoms are chronic, debilitating, and not adequately controlled with medications or conservative therapies.
How It Is Performed
Trial Phase
A temporary system is placed through the skin under local anesthesia and mild sedation.
Leads are guided into the epidural space of the spine.
An external stimulator delivers electrical pulses to assess symptom relief.
The trial lasts 5–7 days. If you experience at least 50% pain relief, you may be a candidate for permanent implantation.
Permanent Implantation
The leads are secured in place and a small pulse generator is implanted under the skin (usually in the lower back or buttock).
The device is programmed and controlled wirelessly.
Procedure is outpatient and takes about 1–2 hours.
Pre-Procedure Instructions
Medication Management: Follow your doctor’s instructions on holding blood thinners and diabetes medications.
Fasting: Do not eat or drink after midnight before the procedure.
Transportation: Arrange for someone to drive you home.
Medical Review: Ensure good blood sugar control and stable medical conditions prior to scheduling.
Post-Procedure Instructions
Activity Restrictions: Avoid bending, twisting, reaching overhead, or lifting objects heavier than 10 lbs for 4–6 weeks.
Wound Care: Keep incision sites clean and dry; avoid swimming or soaking until cleared.
Pain Management: Mild soreness is normal. Use prescribed medication as directed.
Follow-Up: Attend scheduled appointments for device programming and wound checks.
When to Call: Notify your provider if you experience fever, drainage from the wound, leg weakness, or loss of bowel/bladder control.
Evidence Supporting SCS for Diabetic Neuropathy
Several high-quality studies support the use of SCS for DPN:
SENZA-PDN Study (Petersen et al., 2021, JAMA Neurology)
A randomized controlled trial of 216 patients showed that 10 kHz high-frequency SCS significantly reduced pain and improved quality of life in DPN patients who had failed conventional therapy.
Results: 76% of SCS patients had ≥50% pain relief at 6 months versus 3% in the control group.
Reference: Petersen EA et al. High-Frequency 10-kHz Spinal Cord Stimulation Improves Pain Relief and Quality of Life in Painful Diabetic Neuropathy. JAMA Neurol. 2021;78(6):686-695.
Slangen et al., 2014, Diabetes Care
A prospective study showed long-term pain reduction and improved sleep quality and mood in DPN patients receiving SCS.
Reference: Slangen R et al. Spinal cord stimulation and pain relief in painful diabetic peripheral neuropathy: a prospective two-center randomized controlled trial. Diabetes Care. 2014;37(11):3016-3024.
FDA Approval (2021)
The FDA approved the use of 10 kHz SCS for painful diabetic neuropathy in 2021 based on strong evidence from randomized trials.
Conclusion
Spinal Cord Stimulation offers a safe, effective, and reversible treatment option for patients suffering from painful diabetic peripheral neuropathy who have not responded to standard therapies. It may significantly reduce pain, improve function, and restore quality of life.
Talk to your provider to learn whether you may be a candidate for spinal cord stimulation.