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Duarte RV, Nevitt S, Maden M, et al. Spinal cord stimulation for the management of painful diabetic neuropathy: a systematic review and meta-analysis of individual patient and aggregate data. Pain. 2021 Mar 9. pii: 00006396-900000000-98102. doi: 10.1097/j.pain.0000000000002262. (Systematic review)
Abstract

ABSTRACT: Spinal cord stimulation (SCS) has been suggested as a treatment option for patients with painful diabetic neuropathy (PDN). We conducted a systematic review and undertook a meta-analysis on individual patient data from randomised controlled trials (RCTs) to assess the effectiveness of SCS for the management of PDN. Electronic databases were searched from inception to May 2020 for RCTs of SCS for PDN. Searches identified 2 eligible RCTs (total of 93 patients with PDN) and 2 long-term follow-up studies of one of the RCTs. Individual patient data were obtained from the authors of one of these RCTs. Meta-analysis showed significant and clinically meaningful reductions in pain intensity for SCS compared with best medical therapy alone, pooled mean difference (MD) -3.13 (95% confidence interval [CI]: -4.19 to -2.08) on a 10-point scale at the 6-month follow-up. More patients receiving SCS achieved at least a 50% reduction in pain intensity compared with best medical therapy, pooled risk ratio 0.08 (95% CI: 0.02-0.38). Increases were observed for health-related quality of life assessed as EQ-5D utility score (pooled MD 0.16, 95% CI: 0.02-0.30) and visual analogue scale (pooled MD 11.21, 95% CI: 2.26-20.16). Our findings demonstrate that SCS is an effective therapeutic adjunct to best medical therapy in reducing pain intensity and improving health-related quality of life in patients with PDN. Large well-reported RCTs with long-term follow-up are required to confirm these results.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
Comments from MORE raters

Physician rater

Although this is an interesting meta-analysis of individualized patient data with the aim to investigate the effectiveness of spinal cord stimulation for the management of painful diabetic neuropathy, the total included population is very limited and further investigation is warranted.

Physician rater

Importance of this paper to practicing endocrinologists is limited by 1) small number of patients, and 2) fact that this treatment would be initiated by pain management professionals/neurologists. It might be helpful to be aware of these 2 small RCTs if endos are in areas where this treatment is possible to be able to discuss with patients.

Rehab Clinician (OT/PT) rater

As a Physical Therapist, I find the information in this article is informative about the possibility of referring a patient with painful diabetic neuropathy to a specialist for SCS. Prior to reading this article, I would not have thought about the possibility of SCS for PDN.

Rehab Clinician (OT/PT) rater

While this study is indirectly related to physical therapist practice, it is highly important to understand that this treatment is available.
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