Electrical spinal cord stimulation in painful diabetic polyneuropathy, a systematic review on treatment efficacy and safety

Introduction: Painful diabetic polyneuropathy is a common complication of diabetes mellitus. Drug therapies are ineffective in many patients. Therefore other treatment modalities should be considered, including spinal cord stimulation. We performed a systematic review to evaluate treatment efficacy and safety of spinal cord stimulation in painful diabetic polyneuropathy. Search strategy and selection criteria: A systematic search with reference tracing was conducted in Pubmed and Embase from January 1980 to March 2010 to determine possible eligible articles. Reports were identified using the following keywords: (1) "diabetic neuropathies" AND "electric stimulation"; (2) "diabetic neuropathies" AND "spinal cord" and (3) "pain" AND "electric stimulation" AND "spinal cord". Subsequently, data were recruited on the efficacy and safety of spinal cord stimulation in this disorder. Data collection and analysis: The search strategy was designed by one reviewer. Study selection and data extraction were performed by two reviewers. Data for individual studies was reported and pooled data analysis was performed if appropriate. Results: Three prospective case series and one retrospective cohort study were identified (including 25 patients). At 1 year spinal cord stimulation resulted in >= 50% pain relief in 63% of patients. After 1 year analgesics usage was reduced in most SCS-treated patients with complete withdrawal in 60%. No major adverse events were reported. Conclusion: Available literature shows promising results for the pain-relieving effect of spinal cord stimulation in painful diabetic polyneuropathy. The outcome of a randomized clinical trial is needed before spinal cord stimulation can be considered to be integrated in the standardized treatment algorithm.