Evaluating Spinal Cord Stimulation on Diabetic Neuropathy
We have long used the metaphor of 10-kHz spinal cord stimulation as a
kind of “noise-cancelling headphones” for painful diabetic
neuropathy—filtering out the painful background signal and perhaps
allowing useful sensation to be heard again. This new randomized
controlled trial suggests the story may be even more interesting.
In PDN-Sensory, 79.4% of participants treated with 10-kHz SCS achieved
at least 50% lower-limb pain relief in the conservative modified
intention-to-treat analysis, versus 4.0% with conventional medical
management. Objective sensory improvement occurred in 55.2% versus
25.0%, and lower-calf intraepidermal nerve-fiber density increased by
a mean 56% in the SCS group, with a significant between-group
difference.
The sensory examinations were allocation-blinded, and the biopsy
endpoint gives us an objective structural signal. We are careful not
to overcall this as proven regeneration, but the findings are
consistent with a potential disease-modifying effect and certainly
raise a fascinating question: are we merely cancelling the noise—or
might the wiring itself be changing too?
—David Armstrong, DPM, MD, PhD; et al.
Reference:
Hurley RW, Siraj ES, Sills S, et al. Evaluating Improvement in Pain
and Sensory Function When Using High-Frequency (10-kHz) Spinal Cord
Stimulation in Individuals With Painful Diabetic Neuropathy: A
Multicenter Randomized Controlled Trial (PDN-Sensory). Diabetes Care.
