What to Expect from Spinal Cord Stimulation Treatment for Diabetic Peripheral Neuropathy

A spinal cord stimulator is a device implanted near your spine designed to relieve pain by sending low levels of electricity directly to the spinal cord. The idea of having a device implanted and affecting your spine may sound scary, but knowing what the process looks like can help you better understand how it works to relieve the pain from diabetes-related peripheral neuropathy (DPN).

Consultation and Trial Period:

The process begins with a consultation with a pain specialist to determine if a spinal cord stimulator (SCS) is a good fit for you. Although SCS is quite effective compared to other treatments for DPN, it’s usually only recommended when other non-surgical treatments, such as different medications, have failed to provide pain relief. That is because it is more invasive and could carry some additional risks.

Similar to other treatments used for DPN, not everyone responds with pain relief. There is a 1-week trial period during which the device is temporarily placed to see if your pain is reduced. If the SCS is effective during that week, the permanent device can later be fully implanted. During the procedure for the trial device, a thin needle is used to place the leads in your back. A surgeon specializing in this procedure uses a specific type of x-ray called fluoroscopy. It is placed in the epidural space, which is situated between the spinal cord and the vertebrae, and during the procedure, you may be asked to give input on the placement and how it feels. During the trial period, the battery pack or stimulator is kept outside your body, typically worn on a belt around the waist. You will get to test it over the week to see if it provides adequate pain relief.

A remote controller, also outside the body, allows you to adjust the stimulation level and turn it on or off. Depending on the device and model, there are different features of automation and intensity levels. The trial is typically considered successful if you experience a 50% or greater reduction in pain level.

What Happens If the Trial is Not Successful?

The wires can easily be removed in the clinic without damage to the spinal cord or nerves. The trial period is beneficial so you can make an informed decision before having a more invasive surgery. Those who respond well during the trial usually experience ongoing pain relief with continued use.

Spinal Cord Stimulator Implantation Procedure:

After the 1-week trial period, if you’ve gotten significant pain relief (at least 50% improvement) and want to continue with the permanent system, the stimulator can be implanted approximately two weeks later through minimally invasive surgery. The initial leads that were placed will be removed, and permanent ones will be implanted. The new electrodes will be anchored by sutures to minimize their movement.

The stimulator is implanted in the buttocks or abdomen. The surgery is usually done as an outpatient procedure and takes approximately 1-2 hours. Anesthesia will be used to keep you comfortable and pain-free. Usually, there are two incisions, one along the spine to place the electrodes and the other in the lower abdomen or buttocks to place the stimulator. Similar to the trial period, fluoroscopy determines where the electrodes should be placed. Once everything is connected and running, the incisions will be closed, and you are on your way to recovery and pain relief.

More details can be found here.

Spinal Cord Stimulator Recovery Time:

Overall, the recovery period is generally short, and you should be able to return to normal activities within a few weeks. The incisions could feel painful for several days after the surgery. Therefore, it’s best not to stretch, twist, or reach, which could pull at the incisions. Dressings are placed over the incision sites, which can usually be removed after three days. It’s important to check the incision site daily for signs of infection, such as redness or drainage. Follow your healthcare team’s post-surgery instructions for the next few weeks or until your follow-up visit. Recovery usually takes 2 to 4 weeks after surgery; talk to your doctor about pain medication if needed. Lighter activities are typically recommended for at least 2 weeks after surgery, but it’s best to discuss an individualized plan with your doctor or surgeon.

Risks and Side Effects:

The risks associated with the procedure are uncommon but may include infection at the surgical site, bleeding, and nerve injury. Glucose levels that are above target can increase the risk of infection, so it is important to strive for tighter time-in-range and at-goal A1C levels before the procedure and during your recovery.

Other potential risks could include device malfunction. For example, a fall or intense physical activity could break the stimulator. It’s also possible to experience device migration, where the electrodes move from their original location and do not block the pain as effectively. If this occurs, a follow-up surgery may be required to reposition the electrodes to the right spot.

These devices also have a higher price tag compared to medications, so it’s important to check your insurance coverage for the device and procedures. Insurance plans often require trying several other treatments before providing coverage for SCS.

What to Expect After SCS Implantation:

Most people experience significant pain reduction and improved mobility. Regular follow-ups are necessary to adjust the device settings and ensure optimal pain relief. Procedures like MRIs, CT scans, and X-rays are usually safe, but the stimulator must be turned off. Before getting any type of scan or imaging, it’s important to always consult with your healthcare provider, who is familiar with your specific situation and implant. The SCS should be turned off when driving a car or operating heavy machinery.

If, over time, the stimulator is not providing the needed pain relief, your settings can be adjusted. It’s also important to know if it’s no longer effective, it can be surgically removed.

Long-Term Benefits:

Women with diabetic peripheral neuropathy who receive SCS treatment frequently experience a significant improvement in their quality of life. This enhanced well-being allows them to engage in daily activities they once found challenging, such as washing dishes, doing laundry, cleaning, and grocery shopping, often without the burden of pain. They may also enjoy recreational activities like museum visits, playing with children or grandchildren, shopping, and traveling with greater ease.

Another notable advantage is a reduced dependency on opioid medications, which carry risks of addiction and adverse side effects. Clinical trials indicate that over 50% of those using SCS therapy successfully decrease their use of pain medications. Moreover, SCS treatment facilitates pain-free physical activity, which not only improves overall fitness but is also linked to increased lifespan and better mental health. Many individuals who incorporate regular exercise into their routines report elevated moods and a higher overall quality of life.

DPN is a common complication from diabetes and can be incredibly frustrating, affecting mood, physical function, and activities of daily living. While medications, healthy lifestyle behaviors, and managing glucose levels are first line, for many people this is not enough to control their pain levels. It’s good to be aware of all your treatment options.

Key Takeaways:

• Learn more about the Medtronic spinal cord stimulator
• Spinal Cord Stimulation can offer significant relief from diabetic neuropathy and can be a good option when other treatments have not been successful.
• The Trial Phase allows you to experience how well the device works for you before committing to the full implant.
• Pain relief isn’t just about masking pain; it can help you regain mobility, improve your lifestyle, and even manage diabetes more effectively.

References

• Spinal Cord Stimulator | Johns Hopkins Medicine
• Mallick-Searle T, Adler JA. Update on Treating Painful Diabetic Peripheral Neuropathy: A Review of Current US Guidelines with a Focus on the Most Recently Approved Management Options. J Pain Res. 2024 Mar 13;17:1005-1028.
• 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