If you live with diabetes, then you may have experienced painful diabetic neuropathy (PDN), a type of nerve damage that causes numbness, burning, or tingling most often in the feet and legs, and sometimes in the hands and arms. Chronic, progressive, and potentially debilitating, PDN is one of the most common complications of diabetes and affects as many as 50% of patients. In some people, PDN causes mild symptoms; in others, it is disabling.
Treatments for PDN, including prescription pain medications, such as gabapentinoids, serotonin-norepinephrine reuptake inhibitors, tricyclic antidepressants, topical solutions, and even opioids, produce varying results, according to Dr. Neel Mehta, division chief of Pain Management at Weill Cornell Medicine and NewYork-Presbyterian Hospital. “Traditional over-the-counter medications like Tylenol and Advil do little to ease PDN,” Dr. Mehta says. “Nerve pain medications sometimes work but their success rate is low,” he adds. Some patients try coping with the pain, while others may turn to opioids, which as we know have significant long-term risks including addiction or even overdose, he says. “None of these are great solutions.”
The specialists in WCM’s division of Pain Management offer a unique therapy: high-frequency (10-kHz) spinal cord stimulation (SCS). SCS has been used for 15 years to successfully treat spine-related pain and nerve injuries from accidents or trauma, and is now helping patients with PDN, Dr. Mehta says. “SCS is like a pacemaker for the spine rather than the heart,” he says. “There is nothing like it.”
One major advantage of spinal cord stimulation is that patients can use it on a trial basis. “We implant a temporary stimulator device and send the patient home for a week to try it out,” Dr. Mehta says. “The trial is low risk and allows you to test drive the device.” At the end of the week, a doctor removes the temporary stimulator and, if it was helpful, implants a permanent device during a brief outpatient procedure. It is a procedure increasing in usage at WCM’s Division of Pain Management, by all the fellowship-trained physicians.
SCS entails the permanent implantation of wires in the back that connect to a small battery placed under the skin of the buttocks. This technology--implanted in a same-day, 1.5-hour procedure --delivers a gentle current to the spine that noticeably reduces the symptoms of PDN, Dr. Mehta says. “The procedure is done under sedation and with minimal cutting of skin, and no removal of bone,” he explains.
In one of the largest studies of spinal cord stimulation, sponsored by Nevro Corp.*, 80%-90% of participants who had found no pain relief from medication experienced long-lasting pain relief from SCS. The study followed these participants every three months for two years and found overall improvement in their pain levels, sleep, and other health-related quality of life measures. These benefits were so profound that the U.S. Food and Drug Administration recently approved 10khz SCS as a therapy for PDN.
SCS reduces and may even eliminate the need for oral pain medications. Patients can adjust its intensity based on their pain level. They can also recharge it wirelessly. In fact, the battery lasts 10 years before needing replacement, Dr. Mehta says.
High-frequency SCS is a second-line therapy, indicated only for diabetes patients whose PDN has not responded to any other therapy, Dr. Mehta stresses. “This is not considered the first time someone has neuropathy,” he says. Additionally, if PDN is a new problem, then medication is still worth a try, he says. Patients who take blood thinners, are prone to infection, or cannot tolerate anesthesia should talk with their physician about potential risks of SCS, he adds.
It is also not something that all physicians can offer. “You can’t go to your primary care doctor and expect this treatment,” he says. The team at WCM’s Division of Pain Management is fellowship-trained, board-certified in Pain Medicine, and does this procedure with regular frequency.
SCS poses some rare risks: As with any surgical procedure, there is risk of injury to nerves, bleeding, or infection around the spine
For more information or to schedule a consultation with one of our pain management specialists, please call WCM’s Division of Pain Management at (646) 962-7246.
*Disclaimer: Dr. Neel Mehta is a paid consultant for Nevro Corp.