An overview of painful diabetic peripheral neuropathy: Diagnosis and treatment advancements

Hagedorn, Jonathan M; Engle, Alyson M.; George, Tony K; Karri, Jay; Abdullah, Newaj; Ovrom, Erik; Bocanegra-Becerra, Jhon E.; D’Souza, Ryan S

doi:10.1016/j.diabres.2022.109928

Cited by 9 publications

(10 citation statements)

References 116 publications

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“…Based on existing limited outcomes data, however, we conclude that for PDN, HF 10-kHz SCS, compared with traditional SCS, offers a greater likelihood of significant pain reduction and improved quality of life by eliminating paresthesias as well as allowing for a faster implant procedure. 25,72,106 Nevertheless, more data is needed for both of these forms of FDA-approved technologies for treating PDN.…”

Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Yeung

Huang

Nguyen

et al. 2022

J Diabetes Sci Technol

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Spinal cord stimulation (SCS) technology has been recently approved by the US Food and Drug Administration (FDA) for painful diabetic neuropathy (PDN). The treatment involves surgical implantation of electrodes and a power source that delivers electrical current to the spinal cord. This treatment decreases the perception of pain in many chronic pain conditions, such as PDN. The number of patients with PDN treated with SCS and the amount of data describing their outcomes is expected to increase given four factors: (1) the large number of patients with this diagnosis, (2) the poor results that have been obtained for pain relief with pharmacotherapy and noninvasive non-pharmacotherapy, (3) the results to date with investigational SCS technology, and (4) the recent FDA approval of systems that deliver this treatment. Whereas traditional SCS replaces pain with paresthesias, a new form of SCS, called high-frequency 10-kHz SCS, first used for pain in 2015, can relieve PDN pain without causing paresthesias, although not all patients experience pain relief by SCS. This article describes (1) an overview of SCS technology, (2) the use of SCS for diseases other than diabetes, (3) the use of SCS for PDN, (4) a comparison of high-frequency 10-kHz and traditional SCS for PDN, (5) other SCS technology for PDN, (6) deployment of SCS systems, (7) barriers to the use of SCS for PDN, (8) risks of SCS technology, (9) current recommendations for using SCS for PDN, and (10) future developments in SCS.

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Section: Discussionmentioning

confidence: 99%

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Yeung

Huang

Nguyen

et al. 2022

J Diabetes Sci Technol

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“…This can be a progressive and debilitating condition that can cause painful paraesthesias, with only one-third of patients typically achieving clinically significant pain relief from conventional therapy [44]. Neuromodulation interventions are becoming more common modalities utilized in the treatment of PDN [45][46][47]. Two retrospective studies [8,48] and one case report [49] described DRG-S for treatment of PDN (Table 3).…”

Section: Painful Diabetic Neuropathymentioning

confidence: 99%

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

et al. 2022

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Dorsal root ganglion stimulation (DRG-S) is a form of selective neuromodulation therapy that targets the dorsal root ganglion. DRG-S offers analgesia in a variety of chronic pain conditions and is approved for treatment of complex regional pain syndrome (CRPS) by the US Food and Drug Administration (FDA). There has been increasing utilization of DRG-S to treat various neuropathic pain syndromes of the lower extremity, although evidence remains limited to one randomized controlled trial and 39 observational studies. In this review, we appraised the current evidence for DRG-S in the treatment of lower extremity neuropathic pain using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) criteria. The primary outcome was change in pain intensity after DRG-S compared to baseline. We stratified presentation of results based of type of neuropathy (CRPS, painful diabetic neuropathy, mononeuropathy, polyneuropathy) as well as location of neuropathy (hip, knee, foot). Future powered randomized controlled trials with homogeneous participants are warranted.

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“…Drugs for the symptoms of PDN are not intended to treat the pathophysiological mechanisms of PDN. 63 To be effective, drugs for neuropathy pain must be taken consistently regardless of the level of pain. 1 Four drugs are approved by the United States Food and Drug Administration (FDA) for PDN: (1) pregabalin (a gabapentanoid anticonvulsant), ( 2) duloxetine (a serotonin and norepinephrine reuptake inhibitor), ( 3) tapentadol (a weak to moderate opioid), and ( 4) capsaicin (a topical alkaloid) for foot pain only.…”

Section: Pharmacological Therapymentioning

confidence: 99%

Painful Diabetic Neuropathy: The Need for New Approaches

Yeung

Huang

Nguyen

et al. 2022

J Diabetes Sci Technol

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Painful diabetic neuropathy is a common vexing problem for people with diabetes and a costly problem for society. The pathophysiology is not well understood, and no safe and effective mechanistically-based treatment has been identified. Poor glycemic control is a risk factor for painful diabetic neuropathy. Excessive intraneuronal glucose in people with diabetes can be shunted away from physiological glycolysis into multiple pathological pathways associated with neuropathy and pain. The first three treatments that are traditionally offered consist of risk factor reduction, lifestyle modifications, and pharmacological therapy, which includes only three drugs that are approved for this indication by the United States Food and Drug Administration. All of these traditional treatments are often inadequate for relieving neuropathic pain, and thus, new approaches are needed. Modern devices based on neuromodulation technology, which act directly on the nervous system, have been recently cleared by the United States Food and Drug Administration for painful diabetic neuropathy and offer promise as next-in-line therapy when traditional therapies fail.

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An overview of painful diabetic peripheral neuropathy: Diagnosis and treatment advancements

Cited by 9 publications

References 116 publications

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Spinal Cord Stimulation for Painful Diabetic Neuropathy

Dorsal Root Ganglion Stimulation for Lower Extremity Neuropathic Pain Syndromes: An Evidence-Based Literature Review

Painful Diabetic Neuropathy: The Need for New Approaches

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