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Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review

  • Neuromodulation (A Abd-Elsayed, Section Editor)
  • Published:
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Abstract

Purpose of Review

Painful diabetic neuropathy (PDN) is a prevalent and debilitating condition, characterized by severe burning, tingling, and lancinating pain usually located in the distal lower extremities. In addition to manifesting with severe pain, PDN may also be associated with poor quality of life and sleep, mood disorders, burns, falls, and social withdrawal. The authors appraised the current body of literature for evidence on neuromodulation interventions for PDN.

Recent Findings

In patients with refractory PDN unresponsive to conventional medical management (glucose optimization and oral analgesic medications), there is level I evidence supporting the use of 10-kHz and tonic dorsal column spinal cord stimulation (SCS). Included studies reported significant associations between 10-kHz and tonic dorsal column SCS and superior analgesic outcomes, physical functioning, and patient satisfaction. Current level of evidence remains limited for other modalities of neuromodulation for PDN including burst SCS (level II-3), dorsal root ganglion SCS (level III), and peripheral nerve stimulation (level II-3). Some studies reported improvements in neurological physical examination, sensory testing, and/or reflex testing in patients undergoing 10-kHz SCS for treatment of PDN.

Summary

In summary, the purpose of this review is to equip provider with important updates on the use of neuromodulation interventions for the treatment of PDN that is refractory to conventional medical therapy, with current level I evidence supporting use of 10-kHz and tonic SCS for PDN.

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Acknowledgements

We would like to thank Cynthia J. Beeler, M.L.S., AHIP for assisting with the formal search strategy utilized in this review paper.

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Authors and Affiliations

  1. Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA

    Ryan S. D’Souza, Brendan Langford & Marissa Dombovy-Johnson

  2. Department of Anesthesiology and Perioperative Medicine, University of Wisconsin, Madison, WI, USA

    Alaa Abd-Elsayed

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Correspondence to Alaa Abd-Elsayed.

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D’Souza, R.S., Langford, B., Dombovy-Johnson, M. et al. Neuromodulation Interventions for the Treatment of Painful Diabetic Neuropathy: a Systematic Review. Curr Pain Headache Rep 26, 365–377 (2022). https://doi.org/10.1007/s11916-022-01035-9

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