Diabetic neuropathy cannot be reversed, however painful symptoms of diabetic neuropathy can be managed. In fact, new Food and Drug Administration (FDA) approval of spinal cord stimulation for certain patients with painful diabetic neuropathy opens the door for many more patients who are suffering from debilitating, and discouraging, painful diabetic neuropathy to find relief.
Why do I find this so exciting? Nearly 80% of patients with refractory (does not respond to medication) painful diabetic neuropathy who underwent spinal cord stimulation experienced pain reduction and improved quality of life, according to a landmark clinical trial published in JAMA Neurology. Spinal cord stimulation is a procedure involving implantation of electrodes near the spine to stop pain signals from reaching the brain. The Boston Scientific spinal cord stimulator we use offers a number of customizable programming options that can minimize or reverse unwanted sensory side-effects.
It’s important to understand that not all people with diabetes will experience neuropathy, and not all people with painful diabetic neuropathy will qualify for spinal cord stimulation. Let me explain more about diabetic neuropathy, painful diabetic neuropathy, and treatment options.
What is diabetic neuropathy?
Peripheral neuropathy–meaning damage to the nerves outside of the brain and spinal column–is the most common type of neuropathy in diabetic patients and often affects the legs and feet.
Diabetes is a chronic condition caused when your body cannot properly turn blood sugars into energy. Roughly 15% of adults in the US have diabetes, which can affect nearly every function in your body, from your head to your toes. One in two adults with diabetes will develop neuropathy, according to a 2019 study published in Current Diabetes Reports, and about 20% of those will experience painful diabetic neuropathy that requires treatment.
What does painful diabetic neuropathy feel like?
Painful diabetic neuropathy is often described as unbearable or excruciating burning, tingling, stabbing, or numbing pain. Some patients have noted that they feel sharp needle-like pain in the foot at night or burning heel pain at night in bed, although the pain can occur at any time.
The pain can be sporadic or constant and feels different in different people. Most people with diabetic neuropathy will answer yes to one of these questions:
- Do your feet hurt at night? Are sheets irritating or painful?
- Do you feel like you are walking on nails, broken glass or marbles?
- Do you feel like ants are stinging your feet?
- Does it feel like your feet are on fire?
Patients with diabetes who are most likely to develop diabetic neuropathy are those who smoke, abuse alcohol, don’t manage their glucose levels, are obese and/or have high blood pressure. The risk of diabetic neuropathy increases with age and is more common in women.
What treatments are available for diabetic neuropathy?
People with diabetic neuropathy are usually treated first with:
- Lifestyle and behavior changes
- Improved management of your diabetes
- Physical therapy
- Gabapentinoid anticonvulsants (gabapentin or pregabalin)
Diabetic neuropathy is notoriously difficult to treat with medical management alone. When looking for treatment for neuropathy in the legs and feet near me, you should look for a primary care physician or endocrinologist who is expert at diagnosing and treating diabetic neuropathy. Your physician should conduct a thorough medical history and physical exam to diagnose you with diabetic neuropathy. Imaging, nerve, and conduction studies are rarely needed to diagnose diabetic neuropathy. You will want to have a physician who can work closely with you to recommend and monitor lifestyle changes as well as improved management of your diabetes. You would also benefit from having a physician who can recommend a physical therapist or offers that treatment in their office. When finding a neuropathy doctor near me in Denver, you should look for one who:
- Can provide robust conservative treatments include several different types of medications
- Offers convenient physical therapy, acupuncture, and massage in office or through a close referral network
- Knows when your pain has reached a level that you should be referred on to a neurosurgery team like Neurosurgery One that offers interventional pain management and spinal cord stimulation
Four spinal cord stimulation devices have been approved by the FDA to treat patients with painful diabetic neuropathy who have not found adequate pain relief with medication. Spinal cord stimulation has been studied in patients with painful diabetic neuropathy since the 1990s, so we have plentiful evidence it is effective. For instance, a large randomized study published in Diabetes Care in 2022 found that spinal cord stimulation has positive long-term benefits for many patients with painful diabetic neuropathy. In particular, the study found that high-frequency spinal cord stimulation (they type we use at Neurosurgery One):
- Did not induce paresthesia, an advantage for patients with uncomfortable paresthesia (the feeling of tingling, numbness or “pins and needles”)
- Markedly improved (by nearly 62%) sleep disturbances due to pain, a common ailment for PDN patients
Who is a candidate for spinal cord stimulation for painful diabetic neuropathy?
If you have diabetic neuropathy and the treatments I outlined above haven’t provided relief, you should consider a referral to a neurosurgeon who can assess you for spinal cord stimulation.
To qualify for spinal cord stimulation, you must have:
- A painful diabetic neuropathy diagnosis
- Experienced painful diabetic neuropathy for 6-12 months and have failed at least 1-2 classes of medication
- Lower limb pain
IMPORTANT NOTE: You should see a neurologist or neurosurgeon before taking opioids for your pain! Opioids do not help reduce peripheral neuropathy pain and the use of opioids makes additional treatments, including spinal cord stimulation, less likely to be as effective.
How long does it take to get spinal cord stimulation?
At Neurosurgery One, the process from initial appointment to spinal cord stimulator implantation takes about 8-10 weeks for qualified candidates. To determine if you may benefit from spinal cord stimulation, we’ll review your health history, and you’ll undergo an MRI and psychological evaluation.
To help get this process started as soon as possible—usually within 3-5 days of calling our office—we will schedule your initial assessment with one of our APPs (advanced practice providers), either a physician assistant or a certified nurse practitioner. Your APP will order the needed tests and schedule your spinal cord stimulator trial.
The trial lasts between 3-7 days and gives you the opportunity to know whether the treatment will work before you go through the procedure to have the spinal cord stimulator implanted. Roughly 80-90% of our patients who have a trial choose to have the implant. We typically can schedule you for implantation within 2 weeks of your trial. We perform the minimally invasive procedure at our outpatient surgery centers.
While spinal cord stimulation is not new, I find its application for patients with retractable painful diabetic neuropathy to be exciting. As studies show, up to 80% of patients could experience significant pain relief and improved quality of life.
Abhijeet Gummadavelli, MD, is a fellowship-trained neurosurgeon with Neurosurgery One in Littleton. He specializes in stereotactic and functional neurosurgery as well as spinal cord stimulation and a variety of spinal and brain surgeries. He has nearly a decade of neurosurgery experience and recently completed a fellowship in stereotactic functional and epilepsy neurosurgery at Vanderbilt University Medical Center. He is a talented researcher, having studied brain research for nearly 20 years. He also is an accomplished author, having co-authored 18 publications and been the lead author on 9 pieces, including research that was published in Neurosurgery, Epilepsia, and Frontiers in Neuroscience. He has also contributed to 50 research presentations and abstracts and 5 textbook/chapter publications.