Spinal cord stimulation efficacy sustained in patients with diabetic polyneuropathy
medwireNews: Patients with painful diabetic polyneuropathy continue to experience pain relief in the lower extremities for at least 5 years of spinal cord stimulation (SCS), suggest study findings.
The researchers found that SCS was successful in 86% of 36 patients 1 year after receiving a permanent implant and in 55% of 22 patients after 5 years, and survival analysis estimated that 80% of patients still used their SCS device after 5 years.
“Because SCS treatment is maintained over at least 5 years in patients with [painful diabetic polyneuropathy] and >50% of patients still use their initial SCS device after 5 years, SCS can be considered a cost-effective long-term treatment modality in patients with [painful diabetic polyneuropathy],” says the team.
Treatment success was based on achieving at least a 50% decrease in day or night numerical rating scale (NRS) pain score or a Patient’s Global Impression of Change (PGIC) score of 6 or above (much improved or very much improved).
Specifically, at 5 years, average NRS scores had decreased from 6.7 at baseline to 4.3 during the day and 4.6 during the night, and 36% and 32% of patients had achieved at least a 50% reduction in day and night scores, respectively.
PGIC improvement for pain and sleep was seen in a corresponding 50% and 32% of patients after 5 years.
Maarten van Beek (Maastricht University Medical Center, the Netherlands) and colleagues note in Diabetes Care that no associations were observed between baseline factors and SCS success, but a higher baseline Michigan Diabetic Neuropathy Score (MDNS) was significantly associated with SCS failure, increasing the risk for subsequent removal of the system 3.9-fold.
The researchers stress, however, that despite this association, 40% of patients with the highest MDNS still used their SCS device after 5 years.
“Therefore, patients with [painful diabetic polyneuropathy] with a high mean MDNS should not be deprived of SCS treatment,” they say.
“However, the results can help to inform patients with [painful diabetic polyneuropathy] who are seeking SCS treatment.”
Conversely, there was also a significant, albeit modest, association between higher NRS scores at night and a reduced risk for treatment failure, which van Beek and colleagues attribute to “the therapeutic window for SCS being smaller with a lower baseline pain score.”
By Lucy Piper
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