ON PAIN: SCS Use Expands to Diabetic Peripheral Neuropathy

Spinal cord stimulation (SCS) has long been tested in patients with back and leg pain. However, new patient groups are coming to light, such as those with diabetic peripheral neuropathy. Erika Petersen, MD, FAANS, FACS, spoke to Pain Medicine News on her ongoing research treating this condition with 10-kHz SCS.

Petersen is a professor of neurosurgery and the director of the Section of Functional and Restorative Neurosurgery at the University of Arkansas for Medical Sciences College of Medicine, in Little Rock. Also featured in this episode is Timothy Deer, MD, the CEO and president of the Spine and Nerve Centers of the Virginias in Charleston, W.Va., and a clinical professor of anesthesiology and pain medicine at West Virginia University, in Morgantown. Deer is also a member of the Pain Medicine News editorial advisory board.

Timothy Deer, MD  00:02
My friend Erika Petersen [MD, FAANS, FACS] led a study on diabetic peripheral neuropathy with higher frequency [SCS]. I thought that was fascinating that she had good responses there. So that then that would be—think about the number of people with diabetic peripheral neuropathy. It’s a, it’s just a terrible problem. So I was very encouraged by that.

Erika Petersen, MD, FAANS, FACS  00:28
People have noticed all along, that you know, and I've had patients who had back surgery, but they also were diabetics. And when we did a stimulator to mostly help their back and leg pain, they might tell us that their feet felt better also, and we’re kind of like, “Well, that’s great.” You know, it’s a, it’s an added kind of bonus that wasn’t the original goal, but it certainly was good to see that they were having benefit from multiple of their pain conditions. 

Meaghan Lee Callaghan  00:52
Can you talk a little bit more about the research you’re doing now? 

Petersen  00:54
Yeah, absolutely. So the clinical research study that I’m leading is a large randomized trial. It’s actually the largest patient-enrolled trial in spinal cord stimulation for diabetic painful neuropathy. We have 18 centers in the U.S. participate—a combination of private practice and academic medical centers—and we ultimately enrolled about 400 and change patients. And so we reported initially the three-month preliminary data at NANS [the annual meeting of the North American Neuromodulation Society] in January of 2020. And that was our primary end point three-month data, and that showed significant improvement in pain in the stimulator arm compared to the CMM conventional medical management arm, and also showed that none of those patients had any progression of neurological deficit from their baseline numbness or other deficits documented at the start of the study. We are now just finishing pulling together the six-month data from all those patients, which will take both of the arms through that crossover point, and we’ll be presenting that data at the NANS meeting in January, but it appears to be the same or better, hopefully, you know, as to where we were at the three-month data point.

Callaghan  02:11
That’s all really exciting results. 

Petersen  02:12
It’s one thing to say [a patient’s] pain level is lower, but if somebody [a patient] can actually do more because of the pain being better controlled than that, it really translates to improved overall function. And what we saw is that at the three-month data point, people with a stimulator walked 49 meters further on average in six minutes. And those who were just in the conventional medical arm at three months had no change in the distance that they could walk in six minutes. So those functional measures, I think, are a really important correlate to pain control. It’s not just about having pain control, but it is what you can do with it.

—PMN Staff