Boulton AJM, Jensen TS, Luecke T, Petersen EA, Pop-Busui R, Taylor RS, Tesfaye S, Vileikyte L, Ziegler D. Where does spinal cord stimulation fit into the international guidelines for refractory painful diabetic neuropathy? a consensus statement.
Diabetes Res Clin Pract 2023;
206 Suppl 1:110763. [PMID:
38245326 DOI:
10.1016/j.diabres.2023.110763]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 05/30/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND
Although pharmacotherapy with anticonvulsants and/or antidepressants can be effective for many people with painful diabetic neuropathy (PDN), albeit with frequent side-effects, a critical juncture occurs when neuropathic pain no longer responds to standard first- and second-step mono- and dual therapy and becomes refractory. Subsequent to these pharmacotherapeutic approaches, third-line treatment options for PDN may include opioids (short-term), capsaicin 8% patches, and spinal cord stimulation (SCS).
AIM
This document summarizes consensus recommendations regarding appropriate treatment for refractory peripheral diabetic neuropathy (PDN), based on outcomes from an expert panel convened on December 10, 2022, as part of the Worldwide Initiative for Diabetes Education Virtual Global Summit, "Advances in the Management of Painful Diabetic Neuropathy."
PARTICIPANTS
Nine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert.
EVIDENCE
For individuals with refractory PDN, opioids are a high-risk option that do not provide a long-term solution and should not be used. For appropriately selected individuals, SCS is an effective, safe, and durable treatment option. In particular, high-frequency (HF) SCS (10 kHz) shows strong efficacy and improves quality of life. To ensure treatment success, strict screening criteria should be used to prioritize candidates for SCS.
CONSENSUS PROCESS
Each participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting.
CONCLUSION
Globally, the use of opioids should rarely be recommended for refractory, severe PDN. Based on increasing clinical evidence, SCS, especially HF-SCS, should be considered as a treatment for PDN that is not responsive to first- or second-line monotherapy/dual therapy.
Collapse