Painful Diabetic Neuropathy

Diabetic neuropathy may cause numbness and burning pain in a distal, symmetric distribution, typically involving the hands and feet. Management is with improved glucose control and treatment with tricyclic antidepressants, serotonin and norepinephrine reuptake inhibitors, and anti-epileptics. Surgical treatment is reserved for those patients with severe symptoms, with significantly impaired quality of life, for whom medications have not provided significant relief. There is evidence that spinal cord stimulation can provide a significant reduction in pain. A temporary trial of stimulation should be performed prior to permanent implantation. Leads may be placed in the epidural space percutaneously or via laminectomy and are connected to an internal pulse generator. Complications are typically device related. Treatment of device infection may require device removal.