Spinal cord stimulation brings new hope to painful diabetic neuropathy

Dr Sarah Love Jones

Consultant in Pain Medicine & Anaesthesia, Specialty Lead Pain Clinic North Bristol NHS Trust, Elected Council Member, British Pain Society

Dr Ganesan Baranidharan

Consultant in Anaesthesia and Pain Medicine, Leeds Teaching Hospitals NHS Trust, Honorary Clinical Associate Professor, University of Leeds

People with diabetes can often live in excruciating pain, yet spinal cord stimulation technology exists to offer them safe and effective relief.

People with diabetes are living with significant long-term pain that could be effectively and safely managed through spinal cord stimulation. Such people describe pain in their feet and legs as walking on broken glass. All too often, they are left to cope with ineffective painkillers. Yet, a new study, the largest of its kind, shows that high-frequency (10kHz) spinal cord stimulation can reduce this pain significantly maintained at 18 months, it also found that 63% of patients experienced improvements in motor, sensory, or reflex function in the same time period.

Technology for diabetes complications

Nerve damage or neuropathy is one of the long-term complications of diabetes. Over time, high blood glucose (sugar) levels can damage the small blood vessels that supply the body’s nerves, which can then become damaged and may even disappear. In the feet, this can manifest as loss of feeling, which can lead to injury or falls, or in other people, shooting or burning pain.

In spinal cord stimulation a small device is implanted near the spine, using leads to send electrical impulses to the brain, disrupting the pain ‘signals’ caused by nerve damage.

In some areas of the UK waiting lists for this specialist pain therapy are as low as 18 weeks to receive actual treatment, and candidates for SCS can often go home the same day.

Safe and effective pain relief

Experts with experience in this technology say that those with stable diabetes living with long-term and significant diabetes pain are usually suitable to use this device to gain safe and effective pain relief without any of the risks associated with pain medication. These experts also believe that this therapy, which is approved for use in the NHS by medicines watchdog NICE, remains off the “radar” of knowledge of most diabetic care teams, or is wrongly considered unsafe or ineffective.

However, studies show that 86% of people will see their pain reduced by 50% or more and the average pain relief at 18 months is 76%. Latest research shows that over seven in 10 individuals see significant pain relief continuing at 18 months, and at no extra risk of infection.

In some areas of the UK waiting lists for this specialist pain therapy are as low as 18 weeks to receive actual treatment, and candidates for SCS can often go home the same day. So why aren’t people accessing this therapy?

Finding effective treatment options

Dr Sarah Love Jones, lead clinician for Spinal Cord Stimulator Service in the Pain Clinic, North Bristol NHS Trust (NBT), believes that for too long diabetics have simply accepted painful neuropathy as part of their condition and do not push their healthcare professional to consider a referral. But it doesn’t need to be so, she says: “We know patients don’t want to live with this pain.”

Dr Ganesan Baranidharan, Lead Clinician for the Pain team at Leeds Teaching Hospitals and an Honorary Associate Professor at the University of Leeds, feels that existing diabetic check appointments are a golden opportunity to raise the possibility of SCS to suitable patients. Another solution could be to add it to the health checks that GPs are paid to deliver. He says: “There will be a lot of people out there that we can help.”

Read about the patient experience – follow the link below.