Spinal Cord Stimulation Systems: A Breakthrough for Women with Diabetes-Related Peripheral Neuropathy

Spinal Cord Stimulation (SCS) is an advanced treatment for diabetes-related peripheral neuropathy (DPN). It sends electrical impulses to the spinal cord to disrupt pain signals before they reach the brain. This can provide an alternative form of pain relief without medication, which can have side effects and may not provide effective pain relief over time. Recently, the Food and Drug Administration (FDA) has approved several spinal cord stimulation devices for painful DPN. Despite the more recent FDA approvals, these devices have actually been used for decades to treat other pain conditions. Over time, the devices have improved to become smaller and have additional settings for a more individualized approach to improving pain.

How Spinal Cord Stimulators Work:

Spinal cord stimulators are implanted through a minimally invasive procedure. The device consists of thin wires, also called leads, and a small battery pack. The wires are placed in the epidural space, which is situated between the spinal cord and the vertebrae. The battery pack that powers the device, also referred to as a stimulator or generator, is placed under the skin, usually near the buttocks or abdomen. Depending on the type, the battery pack may be rechargeable through the skin. Rechargeable batteries usually last longer in the body, up to 15 years, compared to those that are not rechargeable. Charging is usually done through the skin via a handheld portable charger. Pain relief occurs from electrical pulses to the spinal cord. Most devices contain a remote control that remains outside the body. You can adjust the electrical impulses when you feel pain.

Spinal cord stimulation interrupts the transmission of pain signals, providing relief from chronic neuropathic pain that is often unresponsive to medication. Depending on the device, there may be low-frequency and high-frequency options for pain relief. Initially, a trial period tests the effectiveness before full implantation. During the trial, temporary wires are placed near the spinal cord and connected to the external battery pack. If the person feels pain relief after one week, the trial is considered successful, and the complete system can be permanently implanted.

Benefits of Spinal Cord Stimulation:

The major benefit of spinal cord stimulation is a reduction in pain. Many of the medications used to treat DPN have side effects, and some, like opioids, can be addictive. Many times, medication alone does not bring relief of symptoms. In fact, one study showed that 50% of individuals discontinued their DPN medication within three months of use. In addition to side effects, medications may not be very effective. They often require titrating to a higher dose for pain relief, which can take time and increase the risk of side effects. The use of SCS can significantly reduce the need for medications. Another benefit is improved quality of life. It allows women to regain the ability to move more easily and engage in physical activities that may have been too painful before. SCS can also positively affect mood, sleep, and the ability to work since these are all generally improved with pain relief.

Integrating Spinal Cord Stimulation with Lifestyle Changes:

Spinal cord stimulation works even better when it’s used with other pain management treatments, including physical therapy, exercise, and relaxation methods. Conditions like depression and anxiety can worsen pain, so if those are present, it’s important to treat them as well.

Since spinal cord stimulation helps with pain relief, it can be effectively integrated with lifestyle changes to improve your health. For example, pain relief allows for more movement and regular exercise, which is so good for your health. A recent study showed that at any age, adding physical activity can add more years to your life. With the spinal cord stimulator in place, lower-impact activities like swimming and walking are recommended since they won’t put pressure on sensitive areas where the device is located. If you are less focused on your pain, it may be easier to maintain healthy, balanced eating habits. As discussed previously, the Mediterranean eating plan, which incorporates colorful vegetables and fruits, nuts, seafood, whole grains, healthy fats, and moderate amounts of yogurt, cheese, eggs, and meat, is a healthy way of eating.

Clinical Success:

Clinical studies are performed to prove the benefit of treatment. The highest quality is a randomized, controlled trial where people are randomly assigned to use a spinal cord stimulator or to a control group using “usual care” with medications. Their outcomes are compared. Based on these clinical trials, some of the benefits experienced by people with DPN are:

• 70% of those implanted with an SCS system to treat painful DPN experience treatment success defined by improvement in their pain symptoms.
• Decreased nighttime and daytime pain in a majority of patients using SCS systems throughout the 5-year follow-up.

• The majority of people using SCS experience meaningful pain relief through 8 to 10 years of treatment.
• SCS, compared to conventional treatment, is 17 times more likely to provide significant pain relief.
• People experienced significant improvements in quality of life after SCS therapy.

Key Take Aways

DPN is present in up to 30% of those living with diabetes. It’s one of the common complications that can occur due to nerve damage from elevated glucose levels over time. DNP can’t be reversed, so the focus is on pain relief. Oral medications, topical therapies, and lifestyle changes are usually tried first, but these alone may not be effective enough for many people. Over time, it’s possible for DPN to progress and for pain relief from previously effective therapies to diminish. Spinal cord stimulation is a non-drug therapy that can provide significant pain relief. It starts with a 1-week trial period, so you generally know if you will be a good responder and can make an informed decision before having the device fully implanted. Although it requires surgery, it’s usually done quickly as an outpatient. Once the recovery period is over, there are few restrictions on activities, and most people are able to perform more daily activities because their pain levels have significantly decreased.

It’s good to know what options are available so you can ask your healthcare provider if SCS could be a good option for you or someone experiencing DPN. The first step is to communicate with your healthcare team and request a referral to a pain specialist to learn more about your options.

Learn more about the Medtronic spinal cord stimulator.

References

• American Diabetes Association Professional Practice Committee. 12. Retinopathy, neuropathy, and foot care: Standards of Care in Diabetes—2024. Diabetes Care 2024;47(Supp. 1):S231-S243.
• Martinez-Gomez D, Luo M, Huang Y, Rodríguez-Artalejo F, Ekelund U, Sotos-Prieto M, Ding D, Lao XQ, Cabanas-Sánchez V. Physical Activity and All-Cause Mortality by Age in 4 Multinational Megacohorts. JAMA Netw Open. 2024 Nov 4;7(11):e2446802.
• Zuidema X, van Daal E, van Geel I, et al. Long-term Evaluation of Spinal Cord Stimulation in Patients With Painful Diabetic Polyneuropathy: An Eight-to-Ten-Year Prospective Cohort Study. Neuromodulation. 2022 Dec 30:S1094-7159(22)01403-9.
• Mei Yang, Chunlin Qian, Yifei Liu, Suboptimal Treatment of Diabetic Peripheral Neuropathic Pain in the United States, Pain Medicine, Volume 16, Issue 11, November 2015, Pages 2075–2083, https://doi.org/10.1111/pme.12845
• Clinical evidence on SCS for painful DPN. Minneapolis, MN: Medtronic; 2022. Available from https://www.medtronic.com/content/dam/medtronic-com/us-en/hcp/therapies-conditions/neurological/spinal-cord-stimulation/scs-pdn-clinical-evidence-compendium.pdf

About the Author

Diana Isaacs, PharmD, BCPS, BC-ADM, BCACP, CDCES, FADCES, FCCP, is an Endocrinology Clinical Pharmacy Specialist at Cleveland Clinic, where she co-directs Endocrine Disorders in Pregnancy and leads education in diabetes technology. Board-certified in pharmacotherapy, ambulatory care, and advanced diabetes management, she served on the ADA Professional Practice Committee (2020-2023) and held leadership roles in the ADA and AACE. Dr. Isaacs co-hosts the podcast Diabetes Dialogue and advocates for equitable access to diabetes technologies. Recognized as the 2020 ADCES Diabetes Care and Education Specialist of the Year, she speaks globally on diabetes care. She was inducted into the SIUE Alumni Hall of Fame in 2022 for her impactful contributions.