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Research output: Contribution to Journal/Magazine › Journal article › peer-review
Research output: Contribution to Journal/Magazine › Journal article › peer-review
}
TY - JOUR
T1 - Where does spinal cord stimulation fit into the international guidelines for refractory painful diabetic neuropathy?
T2 - a consensus statement
AU - Boulton, Andrew
AU - TS, Jensen
AU - Luecke, T
AU - Petersen, Erika
AU - Pop-Busui, R
AU - RS, Taylor
AU - Tesfaye, Solomon
AU - Vileikyte, L
AU - Ziegler, D
PY - 2023/12/1
Y1 - 2023/12/1
N2 - BackgroundAlthough pharmacotherapy with anticonvulsants and/or antidepressants can be effective for many people with painful diabetic neuropathy (PDN), albeit with frequent side-effects, a critical juncture occurs when neuropathic pain no longer responds to standard first- and second-step mono- and dual therapy and becomes refractory. Subsequent to these pharmacotherapeutic approaches, third-line treatment options for PDN may include opioids (short-term), capsaicin 8% patches, and spinal cord stimulation (SCS).AimThis document summarizes consensus recommendations regarding appropriate treatment for refractory peripheral diabetic neuropathy (PDN), based on outcomes from an expert panel convened on December 10, 2022, as part of the Worldwide Initiative for Diabetes Education Virtual Global Summit, "Advances in the Management of Painful Diabetic Neuropathy."ParticipantsNine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert.EvidenceFor individuals with refractory PDN, opioids are a high-risk option that do not provide a long-term solution and should not be used. For appropriately selected individuals, SCS is an effective, safe, and durable treatment option. In particular, high-frequency (HF) SCS (10 kHz) shows strong efficacy and improves quality of life. To ensure treatment success, strict screening criteria should be used to prioritize candidates for SCS.Consensus processEach participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting.ConclusionGlobally, the use of opioids should rarely be recommended for refractory, severe PDN. Based on increasing clinical evidence, SCS, especially HF-SCS, should be considered as a treatment for PDN that is not responsive to first- or second-line monotherapy/dual therapy.
AB - BackgroundAlthough pharmacotherapy with anticonvulsants and/or antidepressants can be effective for many people with painful diabetic neuropathy (PDN), albeit with frequent side-effects, a critical juncture occurs when neuropathic pain no longer responds to standard first- and second-step mono- and dual therapy and becomes refractory. Subsequent to these pharmacotherapeutic approaches, third-line treatment options for PDN may include opioids (short-term), capsaicin 8% patches, and spinal cord stimulation (SCS).AimThis document summarizes consensus recommendations regarding appropriate treatment for refractory peripheral diabetic neuropathy (PDN), based on outcomes from an expert panel convened on December 10, 2022, as part of the Worldwide Initiative for Diabetes Education Virtual Global Summit, "Advances in the Management of Painful Diabetic Neuropathy."ParticipantsNine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert.EvidenceFor individuals with refractory PDN, opioids are a high-risk option that do not provide a long-term solution and should not be used. For appropriately selected individuals, SCS is an effective, safe, and durable treatment option. In particular, high-frequency (HF) SCS (10 kHz) shows strong efficacy and improves quality of life. To ensure treatment success, strict screening criteria should be used to prioritize candidates for SCS.Consensus processEach participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting.ConclusionGlobally, the use of opioids should rarely be recommended for refractory, severe PDN. Based on increasing clinical evidence, SCS, especially HF-SCS, should be considered as a treatment for PDN that is not responsive to first- or second-line monotherapy/dual therapy.
U2 - 10.1016/j.diabres.2023.110763
DO - 10.1016/j.diabres.2023.110763
M3 - Journal article
C2 - 38245326
VL - 206
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
SN - 0168-8227
IS - Suppl. 1
M1 - 110763
ER -