Date of Award


Degree Type

Selective Evidence-Based Medicine Review

Degree Name

Master of Science in Health Sciences - Physician Assistant


Physician Assistant Studies

Department Chair

John Cavenagh, MBA, PhD, PA-C


Objective: The objective of this selective EBM review is to determine whether or not “Is spinal cord stimulation an effective therapy to treat severe lower extremity painful diabetic peripheral neuropathy that has lasted over one year and has not responded to medical therapy?”

Study Design: A review of two RCTs and one case series published in English in 2014.

Data Sources: Two RCTs and one case series found via PubMed that evaluated the benefit of spinal cord stimulation (SCS) versus best medical treatment (BMT) to treat severe painful diabetic peripheral neuropathy (PDPN).

Outcome(s) Measured: The amount of pain a patient experiences, measured using either a visual analogue scale with 0 representing no pain and 100 representing the worst pain imaginable, or measured with a numeric rating scale.

Results: All three studies found a significant decrease in pain levels in patients receiving SCS treatment for severe PDPN compared to patients receiving BMT. In the Abd-Elsayed et al. case series, a patient with PDPN reported a 60% overall decrease in pain 1 month post SCS implantation. In the De Vos et al. RCT, the average visual analogue scale (VAS) pain score in patients receiving SCS was reduced from 73/100 to 31/100 (P < 0.001), while the VAS pain score in the control group remained 67/100. 60% of patients in the SCS group experienced at least 50% pain reduction, while only 5% of patients in the control group experienced 50% pain reduction. In the Slangen et al. RCT, treatment success was observed in 59% of patients receiving SCS, while success was observed only in 7% of patients receiving BMT (P < 0.01).

Conclusions: Based on these three studies, pain is significantly decreased in patients experiencing severe PDPN when treated with spinal cord stimulation compared to best medical therapy. The spinal cord stimulator implantation is a surgical procedure that has risks that patients should be made aware of prior to treatment. However, in patients where benefits outweigh the risks, SCS should be considered a treatment option for severe PDPN.