Suffering from diabetes-related pain? Learn about possible treatments

By Todd S. Miller, M.D.

Does this scenario sound familiar? You have diabetes and have been advised to lose weight to get your glucose under control. You know that regular exercise, like walking, is the best way to lose weight, but the sharp pins-and-needles pain or numbness in your feet, otherwise known as diabetic peripheral neuropathy (DPN), makes it too painful to walk. So, you don’t. As a result, you don’t lose weight or even gain more, which increases your glucose and A1C and leads to ongoing or increasing pain and numbness in your feet. Sometimes pain medication works. Too often, it doesn’t.

A simple, safe, minimally invasive outpatient surgical procedure can dramatically ease or possibly eliminate the pain of DPN. It’s called spinal cord stimulation, and it has been proven as a long-lasting therapy for patients whose pain does not respond to traditional management with pain medicine. By reducing pain, spinal cord stimulation allows you to increase your physical activity, and therefore can improve your quality of life.

How does it work?

After having your primary care physician, podiatrist, or neurologist confirm your DPN diagnosis by ruling out other potential causes of your pain such as a spinal condition, vitamin deficiency, or alcoholism, you will be referred to schedule an appointment with a Stamford Health specialist.

If we determine you are a good candidate for the procedure, we’ll perform the first phase of the procedure — the trial partial electrode insertion. We will use two small needles to partially insert stimulating electrodes under your skin near your spine. These electrodes lay over the covering of the spinal cord and connect to a tiny box that’s about the size of a box of Tic Tacs. The end of the electrodes that connects to the box will be left outside the body along with the box that contains a rechargeable battery that operates the electrodes and is secured onto — not under— your skin. This will be wrapped in a sterile fashion to keep you safe. You will be given antibiotics to take while you wear the trial system.

The entire electrode insertion procedure which, like the full procedure, can be performed under IV sedation or local anesthesia, takes about 30 minutes. You will wear the stimulator for a week. If it reduces your pain, then you schedule the second phase of the procedure, to fully insert the electrodes and battery under your skin. This second procedure takes about an hour.

It is very unusual for this procedure to not provide any relief, but if that is the case, we will continue to work with you to find traditional pain management experts and to help you explore other options.

These minimally invasive procedures have short recovery times. During the first week, you may experience mild discomfort from the incision and insertion. By the second week, you’ll feel ready to move. You won’t feel much of anything from the stimulator itself — except an absence of pain! Plus, you’ll be able to get out there and walk, which will help control your glucose. You’ll feel better, and your life and longevity will improve. In fact, patients who have successful trials often want to limit the trial and get to the full implantation as soon as possible because they’re so excited about how much better they feel.

Who is a good candidate for this procedure?

The best candidates for the procedure have severe DPN that has not improved after a trial of medication. The DPN prevents you from exercising and your diabetes continues to be difficult to control.

Up to 50% of people with diabetes have DPN, which occurs when high glucose levels damage nerves in the extremities such as the hands, legs, and feet. Of these, half experience relief with medication. Up to one-quarter of patients with longstanding diabetes who develop this problem receive no help from medication. The best way to lessen the discomfort is to improve glucose control with medication and exercise, like regular walking, but the pain of DPN can make walking too uncomfortable.

If you think you’re a candidate for spinal cord stimulation, then speak with your physician. The procedure is typically covered by Medicare and other types of insurance. It is no exaggeration to suggest that it could change your life.