The most common complication of both types I and II diabetes mellitus (DM) is diabetic peripheral neuropathy, present among more than 50% of individuals living with diabetes. DPN is characterized by superficial burning, numbness, skin hypersensitivity, and pain affecting the feet and lower extremities (1-2). Although pain management via oral medications and topical creams comprises the most common treatment approach, lack of efficacy renders neuropathic pain a physically and emotionally debilitating burden on individuals with DPN. While limited, some data suggest that SCS may have utility as a treatment modality for neuropathic pain associated with DPN (3). The following case descriptions based on retrospective chart review support these earlier literature reports.

Presented here are case summaries of five patients diagnosed with diabetic peripheral neuropathic pain in the lower extremities that were treated with SCS therapy.

All five patients complained of burning, throbbing pain, “pins and needles,” and numbness in their lower extremities, characteristic of DPN. Previous treatments which had provided various levels of temporary relief included nerve blocks, sympathectomy, TENS unit, and opioid therapy. All patients reported immediate and significant pain relief during the trial stimulation as well as maintained pain relief after implantation of the permanent system. In addition to improved sensation and decreased numbness, the feet were described as warmer, reflecting improved circulation. Other positive treatment outcomes included decreased use of opioids and increased comfort during sleep.

SCS treatment was successful in providing continuous pain relief in five patients who had failed other therapies. Secondary to pain relief, patients experienced improved peripheral sensation and circulation, decreased opioid use, and improved sleep. We conclude that SCS therapy should be considered in treating neuropathic pain associated with diabetes, suggesting that the benefits may extend beyond pain relief. A prospective study is planned to more formally investigate these potential secondary benefits.