High-Frequency 10-kHz Spinal Cord Stimulation Improves Health-Related Quality of Life in Patients With Refractory Painful Diabetic Neuropathy: 12-Month Results From a Randomized Controlled Trial.
Publication Title
Mayo Clin Proc Innov Qual Outcomes
Document Type
Article
Publication Date
8-1-2022
Keywords
washington; seattle; swedish
Abstract
Objective: To evaluate high-frequency (10-kHz) spinal cord stimulation (SCS) treatment in refractory painful diabetic neuropathy.
Patients and methods: A prospective, multicenter randomized controlled trial was conducted between Aug 28, 2017 and March 16, 2021, comparing conventional medical management (CMM) with 10-kHz SCS+CMM. The participants had hemoglobin A1c level of less than or equal to 10% and pain greater than or equal to 5 of 10 cm on visual analog scale, with painful diabetic neuropathy symptoms 12 months or more refractory to gabapentinoids and at least 1 other analgesic class. Assessments included measures of pain, neurologic function, and health-related quality of life (HRQoL) over 12 months with optional crossover at 6 months.
Results: The participants were randomized 1:1 to CMM (n=103) or 10-kHz SCS+CMM (n=113). At 6 months, 77 of 95 (81%) CMM group participants opted for crossover, whereas none of the 10-kHz SCS group participants did so. At 12 months, the mean pain relief from baseline among participants implanted with 10-kHz SCS was 74.3% (95% CI, 70.1-78.5), and 121 of 142 (85%) participants were treatment responders (≥50% pain relief). Treatment with 10-kHz SCS improved HRQoL, including a mean improvement in the EuroQol 5-dimensional questionnaire index score of 0.136 (95% CI, 0.104-0.169). The participants also reported significantly less pain interference with sleep, mood, and daily activities. At 12 months, 131 of 142 (92%) participants were "satisfied" or "very satisfied" with the 10-kHz SCS treatment.
Conclusion: The 10-kHz SCS treatment resulted in substantial pain relief and improvement in overall HRQoL 2.5- to 4.5-fold higher than the minimal clinically important difference. The outcomes were durable over 12 months and support 10-kHz SCS treatment in patients with refractory painful diabetic neuropathy.
Trial registration: clincaltrials.gov Identifier: NCT03228420.
Keywords: CMM, conventional medical management; DN4, Douleur Neuropathique; DSPN, diabetic sensorimotor peripheral neuropathy; EQ-5D-5L, EuroQol 5-Dimension 5-Level questionnaire; HRQoL, health-related quality of life; HbA1c, hemoglobin A1c; IPG, implantable pulse generator; NNT, number needed to treat; PDN, painful diabetic neuropathy; RCT, randomized controlled trial; SCS, spinal cord stimulation; VAS, visual analog scale.
Area of Special Interest
Kidney & Diabetes
Area of Special Interest
Neurosciences (Brain & Spine)
Specialty/Research Institute
Nephrology
Specialty/Research Institute
Neurosciences
