Assessing the Efficacy of Spinal Cord Stimulation in Managing Painful Diabetic Neuropathy: A Systematic Review and Meta-Analysis

Abdallah Abbas; Moaz Abouelmagd; Mohamed El-Moslemani; Ahmed Diaa; Ahmed Samir; Mohamed Hatem Ellabban; Ali Bakr; Amira M Taha; Mahmoud Tarek Hefnawy; Mostafa Hossam El Din Moawad; Dina Essam Abo-Elnour; Amna Hussein; Hoda Awad; Alaa Rashad; Ahmed Negida; Ahmed M Raslan

doi:10.1016/j.neurom.2025.01.016

Assessing the Efficacy of Spinal Cord Stimulation in Managing Painful Diabetic Neuropathy: A Systematic Review and Meta-Analysis

Neuromodulation. 2025 Mar 6:S1094-7159(25)00029-7. doi: 10.1016/j.neurom.2025.01.016. Online ahead of print.

Authors

Abdallah Abbas¹, Moaz Abouelmagd², Mohamed El-Moslemani¹, Ahmed Diaa³, Ahmed Samir¹, Mohamed Hatem Ellabban³, Ali Bakr³, Amira M Taha⁴, Mahmoud Tarek Hefnawy⁵, Mostafa Hossam El Din Moawad⁶, Dina Essam Abo-Elnour⁵, Amna Hussein⁷, Hoda Awad², Alaa Rashad⁸, Ahmed Negida⁹, Ahmed M Raslan¹⁰

Affiliations

¹ Faculty of Medicine, Al-Azhar University, Damietta, Egypt.
² Faculty of Medicine, Cairo University, Cairo, Egypt.
³ Faculty of Medicine, Al-Azhar Universe, Cairo, Egypt.
⁴ Faculty of Medicine, Fayoum University, Fayoum, Egypt.
⁵ Faculty of Medicine, Zagazig University, Zagazig, Egypt.
⁶ Faculty of Pharmacy, Clinical Department, Alexandria Main University Hospital, Alexandria, Egypt.
⁷ Department of Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ, USA.
⁸ Department of Neurosurgery, Faculty of Medicine, Al-Azhar Universe, Cairo, Egypt.
⁹ Department of Neurology, Virginia Commonwealth University, Richmond, VA, USA.
¹⁰ Department of Neurological Surgery, Oregon Health & Science University, Portland, OR, USA. Electronic address: raslana@ohsu.edu.

PMID: 40057880
DOI: 10.1016/j.neurom.2025.01.016

Abstract

Background: Diabetes mellitus affects more than half a billion people globally, often leading to painful diabetic neuropathy (PDN). Spinal cord stimulation (SCS) has emerged as a promising treatment for PDN.

Objective: This meta-analysis evaluated the efficacy of SCS compared with the best medical therapy (BMT) for PDN.

Materials and methods: Following the Preferred Reporting Items of Systematic reviews and Meta-Analyses guidelines, a systematic search of the PubMed, Scopus, Web of Science, Embase, and Cochrane CENTRAL data bases was conducted up to December 1, 2023 and updated on January 2, 2025. Data extraction was performed using Microsoft Excel, and quality assessment was conducted using Cochrane's Risk of Bias 2.0 and ROBINS-1 tools. Statistical analysis and heterogeneity assessment were performed using Review Manager (RevMan) software (The Cochrane Collaboration, London, UK).

Results: Nine clinical trials involving 407 patients were included. The analysis revealed significant pain reduction in the SCS group (mean difference [MD]: -5.46, 95% CI: [-6.09, -4.83], p < 0.00001). Subgroup analysis indicated pain relief benefits in both conventional SCS (MD: -4.176, 95% CI: [-4.865, -3.486], p < 0.001) and 10-kHz SCS (MD: -4.581, 95% CI: [-6.376, -2.785], p < 0.001). SCS also achieved higher treatment success rates (≥50% pain relief) than did BMT (risk difference: 0.59, 95% CI: [0.33, 0.85], p < 0.00001). Moreover, SCS significantly improved the EuroQol-5 Dimension utility index (MD: 0.16, 95% CI: [0.10, 0.23], p < 0.00001) and self-reported health (MD: 15.29, 95% CI: [4.51, 26.07], p = 0.005).

Conclusion: This meta-analysis provides robust evidence supporting SCS as an effective intervention for managing chronic pain and enhancing the quality of life in patients with PDN, highlighting its superiority to conventional medical therapy.

Keywords: Diabetes mellitus; SCS; neuromodulation; painful diabetic neuropathy; spinal cord stimulation.

Publication types

Review