Pain relief and quality-of-life improvement after spinal cord stimulation in painful diabetic polyneuropathy: a pilot study.
BACKGROUND
Painful diabetic polyneuropathy (PDP) is associated with high pain scores and is difficult to treat. Therefore, spinal cord stimulation (SCS) has been suggested as second-line treatment. In this study, the feasibility and efficacy of SCS in PDP were investigated, as well as the predictive value of clinical sensory testing for the treatment outcome.


METHODS
Fifteen patients with intractable PDP in the lower limbs were recruited. During lead implantation, the feasibility of achieving adequate paraesthesia coverage using one stimulation lead was investigated. If trial stimulation was successful, a definitive neurostimulator was implanted. Pain intensity was scored using an 11-point numeric rating scale and patients' global impression of change scale. Additionally, neuropathic pain characteristics, quality of life, sleep quality and mood were assessed. The predictive value of clinical sensory testing for the treatment outcome was analysed.


RESULTS
Adequate paraesthesia coverage was achieved in 14 out of 15 patients. Clinically relevant pain relief was present in 11 patients after trial stimulation and 10 patients at 12 months. The quality of life was significantly increased at 2 weeks and 3 months in patients with successful SCS treatment. Several neuropathic pain characteristics and quality of sleep were improved at 2 weeks and 12 months. Preoperative clinical sensory testing did not differentiate between treatment responders from non-responders.


CONCLUSIONS
SCS seems to be an efficacious and feasible treatment for intractable PDP. In this exploratory study, it was not possible to predict the treatment outcome using clinical sensory testing. These results justify performing a randomized clinical trial.
Department of Anaesthesiology and Pain Medicine, Maastricht University Medical Centre, P. Debeijlaan 25, 6229HX Maastricht, The Netherlands. w.pluijms@maastrichtuniversity.nl
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Pluijms
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Slangen
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Bakkers
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Faber
I S J
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Merkies
A G
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Kessels
C D
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Dirksen
E A
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Joosten
J P H
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Reulen
R T
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van Dongen
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Schaper
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van Kleef
D000339:Affect; D000368:Aged; D003863:Depression / Q000209:etiology / Q000523:psychology; D003929:Diabetic Neuropathies / Q000150:complications* / Q000523:psychology; D004567:Electrodes, Implanted; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009437:Neuralgia / Q000209:etiology; D010146:Pain / Q000209:etiology; D059408:Pain Management / Q000379:methods*; D010147:Pain Measurement; D010292:Paresthesia / Q000209:etiology; D010865:Pilot Projects; D011788:Quality of Life; D012890:Sleep / Q000502:physiology; D062187:Spinal Cord Stimulation / Q000009:adverse effects / Q000379:methods*; D016896:Treatment Outcome