학술논문
Where does spinal cord stimulation fit into the international guidelines for refractory painful diabetic neuropathy? a consensus statement.
Document Type
Academic Journal
Author
Boulton AJM; University of Manchester, Manchester, UK. Electronic address: ABoulton@med.miami.edu.; Jensen TS; International Diabetic Neuropathy Consortium, Aarhus University, Aarhus, Denmark.; Luecke T; Pain Center, Franziskus Hospital Linz, Vice President, German Pain Society, Linz am Rhein, Germany.; Petersen EA; University of Arkansas for Medical Sciences, AR, USA.; Pop-Busui R; Metabolism, Endocrinology, and Diabetes, University of Michigan, MI, USA.; Taylor RS; University of Glasgow, Glasgow, UK.; Tesfaye S; Sheffield Teaching Hospitals and the University of Sheffield, Sheffield, UK.; Vileikyte L; University of Manchester, Manchester, UK.; Ziegler D; Institute for Clinical Diabetology, German Diabetes Center, Leibniz Center for Diabetes Research at Heinrich Heine University, Düsseldorf, Germany.
Source
Publisher: Elsevier Scientific Publishers Country of Publication: Ireland NLM ID: 8508335 Publication Model: Print Cited Medium: Internet ISSN: 1872-8227 (Electronic) Linking ISSN: 01688227 NLM ISO Abbreviation: Diabetes Res Clin Pract Subsets: MEDLINE
Subject
Language
English
Abstract
Background: Although 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).
Aim: This 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."
Participants: Nine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert.
Evidence: For 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 Process: Each participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting.
Conclusion: Globally, 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.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)
Aim: This 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."
Participants: Nine attendees, eminent physicians and academics, comprising six diabetes specialists, two pain specialists, and one health services expert.
Evidence: For 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 Process: Each participant voiced their opinion after reviewing available data, and a verbal consensus was reached during the meeting.
Conclusion: Globally, 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.
Competing Interests: Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2023. Published by Elsevier B.V.)