Greater than half of the diabetic population is afflicted with DPN, characterized by burning, numbness, and pain in lower extremities. Approximately 5-10% of this group is prone to developing foot ulcers, often leading to amputation. Current management includes antibiotics, topical medication, wound care, and in extreme cases, skin grafts, none of which are reliably effective. Ulcers can also lead to infection, decreased mobility and activities of daily living (ADLs), and decreased quality of life. SCS therapy has demonstrated effectiveness in treatment of neuropathic pain associated with diabetic and other peripheral neuropathies. Improved circulation with healed ulcers has also been reported. The following retrospective report describes complete healing of a diabetic foot ulcer and improved mobility following treatment of neuropathic pain with the Precision system.

A 78-year old male with a 30-year history of diabetes had ongoing pain from DPN and bilateral vascular insufficiency in lower extremities, but was not a candidate for peripheral revascularization or bypass surgery. A previous ulcer resulted in amputation of one toe. Progressive neuropathic pain and discomfort from a heel ulcer over a one year period led to difficulty in walking, and ultimately, wheelchair limited mobility. After successful trial stimulation, he was implanted with a permanent SCS system.

Following permanent implant, patient reported complete pain relief. The day after the procedure, he was walking with the aid of a cane, and by the tenth day, he was walking without any assistance. His extremities demonstrated improved circulation, and the ulcer was 98% healed by the tenth week.

Although the primary indication for SCS is pain relief, there is an increasing body of evidence suggesting it may have a positive effect on ADLs and quality of life. The magnitude and potential impact of these secondary benefits on public health warrants further study of SCS therapy for alternate indications.