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Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis.
Neuromodulation. 2020 Jun 26 [Online ahead of print]N

Abstract

OBJECTIVES

Neuromodulation is a treatment option for people suffering from painful diabetic neuropathy (PDN) unresponsive to conventional pharmacotherapy. We systematically examined the pain outcomes of patients with PDN receiving any type of invasive neuromodulation for treatment of neuropathic pain.

MATERIALS AND METHODS

MEDLINE and Embase were searched through 10 January 2020, without language restriction. All study types were included. Two reviewers independently screened publications and extracted data. Quantitative meta-analysis was performed with pain scores converted to a standard 100-point scale. Randomized controlled trial (RCT) scores were pooled using the inverse variance method and expressed as mean differences.

RESULTS

RCTs of tonic spinal cord stimulation (t-SCS) showed greater pain improvement than best medical therapy at six months (intention-to-treat: 38/100, 95% CI: 29-47). By per-protocol analysis, case series of t-SCS and dorsal root ganglion stimulation (DRGS) showed improvement by 56 (95% CI: 39-73) and 55 (22-87), respectively, at 12 months. For t-SCS, the rate of failing a therapeutic stimulation trial was 16%, the risk of infection was 4%, and the rate of lead problems requiring surgery to resolve was 4% per year of follow-up. High-frequency SCS and burst SCS both showed efficacy, with few patients studied.

CONCLUSION

Efficacious, lasting and safe surgical pain management options are available to diabetic patients suffering from PDN. Tonic-SCS is the established standard of treatment; however, other SCS paradigms and DRGS are emerging as promising treatments offering comparable pain benefits, but with few cases published to date. Randomized controlled trials are ongoing to assess their relative merits.

Authors+Show Affiliations

Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.Nuffield Department of Anaesthesia, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.Oxford Centre for Diabetes, Endocrinology and Metabolism, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, UK.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32588933

Citation

Raghu, Ashley L B., et al. "Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis." Neuromodulation : Journal of the International Neuromodulation Society, 2020.
Raghu ALB, Parker T, Aziz TZ, et al. Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis. Neuromodulation. 2020.
Raghu, A. L. B., Parker, T., Aziz, T. Z., Green, A. L., Hadjipavlou, G., Rea, R., & FitzGerald, J. J. (2020). Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis. Neuromodulation : Journal of the International Neuromodulation Society. https://doi.org/10.1111/ner.13216
Raghu ALB, et al. Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis. Neuromodulation. 2020 Jun 26; PubMed PMID: 32588933.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Invasive Electrical Neuromodulation for the Treatment of Painful Diabetic Neuropathy: Systematic Review and Meta-Analysis. AU - Raghu,Ashley L B, AU - Parker,Tariq, AU - Aziz,Tipu Z, AU - Green,Alexander L, AU - Hadjipavlou,George, AU - Rea,Rustam, AU - FitzGerald,James J, Y1 - 2020/06/26/ PY - 2020/03/19/received PY - 2020/04/27/revised PY - 2020/05/15/accepted PY - 2020/6/27/entrez KW - Chronic pain KW - SCS KW - meta-analysis KW - neuropathic pain KW - neurostimulation KW - peripheral neuropathy JF - Neuromodulation : journal of the International Neuromodulation Society JO - Neuromodulation N2 - OBJECTIVES: Neuromodulation is a treatment option for people suffering from painful diabetic neuropathy (PDN) unresponsive to conventional pharmacotherapy. We systematically examined the pain outcomes of patients with PDN receiving any type of invasive neuromodulation for treatment of neuropathic pain. MATERIALS AND METHODS: MEDLINE and Embase were searched through 10 January 2020, without language restriction. All study types were included. Two reviewers independently screened publications and extracted data. Quantitative meta-analysis was performed with pain scores converted to a standard 100-point scale. Randomized controlled trial (RCT) scores were pooled using the inverse variance method and expressed as mean differences. RESULTS: RCTs of tonic spinal cord stimulation (t-SCS) showed greater pain improvement than best medical therapy at six months (intention-to-treat: 38/100, 95% CI: 29-47). By per-protocol analysis, case series of t-SCS and dorsal root ganglion stimulation (DRGS) showed improvement by 56 (95% CI: 39-73) and 55 (22-87), respectively, at 12 months. For t-SCS, the rate of failing a therapeutic stimulation trial was 16%, the risk of infection was 4%, and the rate of lead problems requiring surgery to resolve was 4% per year of follow-up. High-frequency SCS and burst SCS both showed efficacy, with few patients studied. CONCLUSION: Efficacious, lasting and safe surgical pain management options are available to diabetic patients suffering from PDN. Tonic-SCS is the established standard of treatment; however, other SCS paradigms and DRGS are emerging as promising treatments offering comparable pain benefits, but with few cases published to date. Randomized controlled trials are ongoing to assess their relative merits. SN - 1525-1403 UR - https://www.unboundmedicine.com/medline/citation/32588933/Invasive_Electrical_Neuromodulation_for_the_Treatment_of_Painful_Diabetic_Neuropathy:_Systematic_Review_and_Meta-Analysis L2 - https://doi.org/10.1111/ner.13216 DB - PRIME DP - Unbound Medicine ER -
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