D'Souza Ryan S, Langford Brendan, Dombovy-Johnson Marissa, Abd-Elsayed Alaa
Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN, USA.
Department of Anesthesiology and Perioperative Medicine, University of Wisconsin, Madison, WI, USA.
Curr Pain Headache Rep. 2022 May;26(5):365-377. doi: 10.1007/s11916-022-01035-9. Epub 2022 Feb 28.
Painful diabetic neuropathy (PDN) is a prevalent and debilitating condition, characterized by severe burning, tingling, and lancinating pain usually located in the distal lower extremities. In addition to manifesting with severe pain, PDN may also be associated with poor quality of life and sleep, mood disorders, burns, falls, and social withdrawal. The authors appraised the current body of literature for evidence on neuromodulation interventions for PDN.
In patients with refractory PDN unresponsive to conventional medical management (glucose optimization and oral analgesic medications), there is level I evidence supporting the use of 10-kHz and tonic dorsal column spinal cord stimulation (SCS). Included studies reported significant associations between 10-kHz and tonic dorsal column SCS and superior analgesic outcomes, physical functioning, and patient satisfaction. Current level of evidence remains limited for other modalities of neuromodulation for PDN including burst SCS (level II-3), dorsal root ganglion SCS (level III), and peripheral nerve stimulation (level II-3). Some studies reported improvements in neurological physical examination, sensory testing, and/or reflex testing in patients undergoing 10-kHz SCS for treatment of PDN. In summary, the purpose of this review is to equip provider with important updates on the use of neuromodulation interventions for the treatment of PDN that is refractory to conventional medical therapy, with current level I evidence supporting use of 10-kHz and tonic SCS for PDN.
疼痛性糖尿病神经病变（PDN）是一种常见且使人衰弱的病症，其特征为通常位于下肢远端的严重灼痛、刺痛和刀割样疼痛。除了表现为严重疼痛外，PDN还可能与生活质量和睡眠不佳、情绪障碍、烧伤、跌倒及社交退缩有关。作者评估了当前关于PDN神经调节干预措施的文献证据。
在对传统药物治疗（血糖优化和口服镇痛药）无反应的难治性PDN患者中，有I级证据支持使用10千赫和强直性背柱脊髓刺激（SCS）。纳入研究报告了10千赫和强直性背柱SCS与更好的镇痛效果、身体功能及患者满意度之间存在显著关联。对于PDN的其他神经调节方式，包括爆发性SCS（II-3级）、背根神经节SCS（III级）和周围神经刺激（II-3级），目前的证据水平仍然有限。一些研究报告称，接受10千赫SCS治疗PDN的患者在神经体格检查、感觉测试和/或反射测试方面有所改善。总之，本综述的目的是为医疗服务提供者提供关于使用神经调节干预措施治疗对传统药物治疗无效的PDN的重要更新信息，目前有I级证据支持使用10千赫和强直性SCS治疗PDN。
